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ALCOHOL:  Its  Use  and  Abuse. 


THE  HOUSE  AND  ITS  SUR- 
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No.  I.  EXERCISE  AND  TRAINING. 
"    2.  ALCOHOL :   ITS  USE  AND  ABUSE. 
"    3.  THE  HOUSE  AND  ITS  SURROUNDINGS 
"    4.  PREMATURE  DEATH :  ITS  PROMOTION 

OR  PREVENTION. 
"    5.  PERSONAL    APPEARANCE    IN    HEALTH 

AND  DISEASE. 
"    6.  BATHS  AND  BATHING. 
"    7.  THE  SKIN  AND  ITS  TROUBLES. 
"    8.  THE  HEART  AND  ITS  FUNCTION. 
"    9.  THE  NERVOUS  SYSTEM. 


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HEAL  TH  PRIMERS. 

1  r// 

ALCOHOL: 

ITS  USE  AND  ABUSE. 


BY 

W.  S.   GREENFIELD,  M.  D. 


NEW  YORK: 

D.    APPLETON    AND    COMPANY, 

I,    3,    AND    5     BOND    STREET. 

1887. 


CONTENTS. 


PACK 

Introduction 5 

Alcohol  and  Alcoholic  Beverages 8 

The  Physiological  Action  of  Alcohol i8 

The  Effect?  of  Alcohol  when  taken  in  Excess.     .  32 

The  Uses  of  Alcohol  and  Alcoholic  Beverages      .  61 

Alcohol  in  Ill-health  and  Disease 79 

The  Right  Use  of  Alcohol      ........  gi 


ALCOHOL: 

ITS    USE    AND    ABUSE. 


INTRODUCTION. 

The  attempt  to  present  in  a  popular  form  a  subject  on 
which  so  much  has  been  said,  and  written,  on  which  so 
great  a  variety  of  opinion  exists,  and  by  which  such  strong 
feelings  and  prejudices  are  excited,  as  that  of  the  use  of 
alcohol,  may  by  many  be  considered  a  rash  one.  But 
seeing  how  important  the  subject  is  to  the  general  health 
and  welfare  of  the  community,  and  how  little  real  influ- 
ence our  store  of  medical  and  physiological  knowledge 
has  had  upon  the  habits  of  our  countrymen,  notwith- 
standing the  eminence  and  ability  of  those  who  have 
written  upon  the  subject,  it  seems  to  be  a  duty  to  endea- 
vour to  place  the  more  important  facts  within  the  reach 
of  all  in  a  simple  form. 

There  is  no  subject  relating  to  health  which  has  a 
greater  practical  importance,  nor  any  on  which  more 
misconceptions  exist.  In  a  perfect  community,  governed 
by   pure   religion,   morality,    and   intelligence,   with   no 


6  ALCOHOL  :    ITS    USE    AND    ABUSE. 

artificial  habits,  and  no  passions  or  vices,  the  use  of 
intoxicating  Hquors  would  need  no  check;  but  in  our 
actual  state,  all  experience  shows  the  dangers  which 
may  and  do  result  from  their  abuse.  But,  as  an  ex- 
ample of  the  many  wrong  ideas  which  exist  as  to  what 
excess  is,  there  are  few,  except  medical  men,  who  know 
what  serious  injury  may  be  done  by  drinking  which  hardly 
ever  approaches  intoxication,  and  which  may  be  unre- 
cognised by  a  man's  nearest  friends.  AVe  shall  try  to 
show  what  is  the  evil  of  drinking,  and  how  to  avoid  it, 
what  the  good  and  how  to  gain  it,  without  joining  in  a 
universal  condemnation  of  the  use  of  alcohol. 

In  the  limits  of  our  space  we  can  only  touch  on  the 
great  questions  involved  ;  we  must  leave  for  the  medical 
profession  the  study  of  the  accumulated  stores  of  scien- 
tific observation  on  the  use  of  alcohol  and  the  results  of 
its  abuse,  from  which  we  shall  only  draw  such  facts  as 
may  seem  to  be  most  useful  for  our  purpose  ;  nor  can  we 
even  refer  more  than  cursorily  to  the  views  of  those  whose 
scientific  and  moral  eminence  lends  weight  to  their 
opinion  as  to  the  usefulness  or  injuriousness  of  alcohol. 
But  we  shall  endeavour  to  give  such  reference  to  more 
extensive  works  as  may  prove  of  service  to  those  who 
seek  the  higher  fountainheads  of  information. 

Nor  let  it  be  supposed  that  because  we  do  not  advocate 
or  condemn  total  abstinence,  we  are  to  be  counted  either 
amongst  its  opponents  or  supporters,  or  that  we  are  blind 


ALCOHOL  :  ITS  USE  AND  ABUSE.  7 

to  the  great  moral  importance  of  the  teetotal  question. 
We  believe  that  an  intelligent  comprehension  of  the 
action  of  alcohol  on  the  system  will  always  have  greater 
influence  with  thoughtful  men  in  promoting  temperance 
than  any  adhesion  to  a  dogma.  Moreover,  we  have  no 
doubt  that  the  moral  and  social  arguments  for  total  absti- 
nence, which  are  after  all  its  strongest  weapons,  but  which 
lie  beyond  the  province  of  our  subject,  will  be  strength- 
ened by  a  calm  consideration  of  what  we  know  of  the 
effects  of  alcohol  in  health  and  disease. 

It  will  be  our  endeavour  to  regard  the  subject  mainly 
from  a  scientific  and  practical  point  of  view,  to  state 
what  is  known  of  the  effects  of  alcohol  on  the  body,  the 
results  of  its  abuse,  and  the  right  occasions  and  methods 
of  its  use,  and  to  draw  only  such  conclusions  as  are 
warranted  by  experience  on  the  ground  of  preservation 
of  health,  avoiding  the  numerous  other  topics  which 
arise  in  connexion  with  the  subject  of  drinking. 

Our  subject  being  Alcohol :  its  use  and  abuse,  we  may 
first  ask  what  alcohol  is,  in  what  way  it  is  usually  taken, 
and  how  much  is  contained  in  ordinary  drinks.  Then  we 
may  examine  its  action  on  the  healthy  system,  and  see 
what  powers  it  possesses — its  so-c3.\lQd/>/iysio/ogicala.ction. 
Further,  we  shall  see  what  is  its  effect  when  taken  in 
excess,  either  for  a  time  or  habitually.  And,  finally, 
having  seen  what  good  it  can  effect  and  what  mischief  it 
may  do,  we  shall  be  in  a  position  to  study  its  use  in 


8  ALCOHOL  :    ITS   USE   AND   ABUSE. 

health  or  disease,  and  draw  such  general  inferences  as 
may  guide  us  in  our  ordinary  habits. 


CHAPTER  I. 

ALCOHOL  AND  ALCOHOLIC  BEVERAGES.^ 

Nearly  all  the  intoxicating  drinks  used  by  man  depend 
for  their  peculiar  properties  on  the  presence  of  a  sub- 
stance known  to  chemists  as  alcoJiol,  This  is  associated 
in  many  cases  with  other  bodies  called  ethers^  which  are 
also  intoxicating,  and  it  is  more  or  less  largely  diluted  with 
water,  and  combined  or  mixed  with  various  substances 
which  give  colour,  taste,  and  smell,  or  which  are  nutri- 
tious, such  as  sugar  and  starchy  bodies,  or  which  have 
other  chemical  properties.  The  amount  of  alcohol  in 
drinks  (to  be  more  precisely  stated  later)  varies  from  i 
part  in  70  (in  small  beer)  to  more  than  i  in  2  (in  strong 
whisky) ;  but  it  can  equally  be  obtained  from  all  by 
distillation. 

^  Pure  alcohol  as  obtained  by  the  chemist  is  a  colourless 
volatile  liquid,  with  a  faint  pleasant  odour  and  but  little 
taste.  It  is  lighter  in  weight  than  water,  its  specific 
gravity  being  796,  boiling  at  172°  Fahr.,  and  it  is  not 
frozen  by  a  cold  of—  166°  Fahr.  If  a  few  drops  of  it  be 
placed  on  the  hand  it  evaporates,  producing  a  sensation 
of  cold  and  slight  tingling.  It  readily  bums  with  a  colour- 
less flame.     It  has  a  strong  attraction  for  water,  so  that, 


ALCOHOL  :    ITS   USE   AND   ABUSE.  9 

if  in  a  moist  atmosphere,  it  dilutes  itself  by  combining 
with  water;  and  if  cold  pure  alcohol  and  water  are 
mixed,  slight  warmth  is  produced  by  their  combination. 
On  account  of  this  property,  and  of  preventing  putre- 
faction, strong  spirit  is  used  to  preserve  animal  and 
vegetable  bodies  and  tissues,  such  as  the  various  creatures 
seen  in  museum  jars,  fruits  for  the  housewife,  &c.  And 
it  very  rapidly  dries  out  the  water  from  anything  with 
which  it  comes  in  contact. 

Chemists  tell  us  that  this  common  or  ''ethylic"  alcohol 
^s  made  up  of  three  elements,  carbon,  hydrogen,  and 
oxygen,  and  they  represent  its  composition  by  the  formula 
CgHgO.  i  When  burnt  with  air  or  oxygen,  it  produces 
water  "and  a  substance  called  carbonic  acid,  which  is 
identical  with  one  of  the  gases  constantly  breathed  out 
from  our  lungs ;  formed,  too,  by  burning  coal,  gas,  oil,  or 
wood,  charcoal,  or  coke,  &c.,  and  which  is  the  substance 
in  the  air  which  makes  it  impure,  unfit  for  breathing,  and 
necessitates  ventilation.* 

In  whatever  shape  it  is  found  naturally  alcohol  always 
results  from  the  process  of  fermentation  of  substances 
containing  sugar^j  and  though  the  chemist  can,  by  com- 
plicated processes,  build  it  up  in  small  quantities  out  of 
its  original  elements,  this  need  not  enter  into  our  calcu- 
lations. To  prepare  pure  alcohol  from  any  of  these  fer- 
mentation products  repeated  distillation  and  other  means 
*  For  other  chemical  details  see  works  on  Chemistiy. 


lo  alcohol:  its  use  and  abuse. 

of  purification  are  necessary,  to  free  it  from  other  volatile 
substances  and  also  from  water,  which  it  holds  with  great 
tenacity;  but  strong  spirits  (containing  from  70  to  90  per 
cent,  of  alcohol)  can  be  obtained  pretty  readily. 

For  purposes  of  diet,  alcohol  is  always  used  in  combi- 
nation, and  the  majority  of  liquors  contain  a  considerable 
number  of  other  substances,  held  in  solution  by  water  ; 
and  the  alcohol  is  probably  combined  more  or  less  inti- 
mately with  these  other  ingredients.  The  more  important 
bodies  are  called  "  ethers  " — bodies  allied  to  alcohol,  and 
also  formed  in  fermentation  or  by  subsequent  chemical 
changes  in  the  alcohol.  It  is  to  these  that  most  of  the 
special  odours  and  '*  bouquet "  of  wines  and  spirits  are 
due  ;  and  they  give  peculiar  stimulating  and  intoxicating 
powers  to  some  wines,  even  when  in  small  quantity. 
Other  "  alcohols,"  differing  in  composition,  but  analogous 
in  nature  to  ethylic  alcohol,  ^'' vieihylicl'  '''•  aiitylic^'  &c., 
are  produced  in  small  quantity  in  some  fermentations; 
e.g.,  amylic  alcohol  is  the  '^  fusel  oil"  which  constitutes 
an  impurity  in  whisky.  They  are  all  more  deleterious 
than  ethylic  alcohol,  and  have  special  poisonous 
properties. 

Besides  these,  the  liquor  contains  usually  colouring 
matter,  and  more  or  less  starchy  and  saccharine  matter, 
with  various  saline  bodies,  such  as  common  salt,  salt  of 
tartar,  &c.,  and  some  essential  oils.  To  give  in  any 
detail  the  various  constituents  of  each  and  their  propor- 


ALCOHOL  :    ITS    USE    AND    ABUSE. 


II 


tlon  would  much  exceed  our  limits.  In  a  general  way 
we  may  say  that  spirits,  brandy,  whisky,  and  gin,  contain, 
if  pure,  no  starch  and  very  little  sugar;  rum,  more 
sugar;  wines,  chiefly  saccharine  and  saline  bodies  with 
ethers  and  essential  oils;  ale,  stout,  and  porter,  much 
starchy  and  "  extractive  "  matter. 

Amount  of  Alcohol  in  various  Liquors. — This  is  the 
most  important  practical  point  for  our  purpose.  Later 
we  must  consider  the  other  ingredients  and  their  action. 

The  following  table  gives  the  average  percentage  of 
alcohol  in  some  of  the  commoner  beverages  : —  * 


Whisky     .      . 

.      .     50  to  60 

Claret- 

Brandy      ,      . 

.      .     50  to  60 

Strongest  Bordeau 

X    17 

Rum    ,      .      , 

.      .     60  to  77., 

Mean    . 

•      15 

Gin      .      .      . 

.     49  to  60 

Vin  ordinaire  . 

S  or    9 

Port  Wine — 

Champagne    .      . 

.       5  to  13 

Strongest    . 
Ordinary     . 
Weakest     . 

.      •     25 
.     23 
.     16-5 

Hock  .      .      .      . 
Sauterne  . 
Cider  .... 

Ale- 

9  to  12 
14 
5  to  10 

Madeira    .      . 

.      .      16  to  22 

Burton  .      . 

9 

Ordinary 

3  to    5 

Sherry — 

Perry  .... 

7 

Strongest   . 

•       25 

Brown  Stout  . 

6  to    7 

Weakest     .      . 

.    16 

London  Porter     . 

4-2 

Burgundy 

.     10  to  14 

London  Small  Beer  . 

1-28 

*  The   statements   here   are   taken   from  the  most   recent  and 
Uiistworthy  sources.     There  is  a  good  deal   of  difference   in   the 


12  alcohol:  its  use  and  abuse. 

It  is  only  right  to  say  that  this  table  gives  only  approxi- 
mate results,  for  the  quantity  of  alcohol  in  wines  or  beers 
of  the  same  name  differs  very  greatly  ;  there  is  no  fixed 
standard.  Perhaps  the  most  useful  way  of  putting  the 
quantity  of  alcohol  is  to  say  how  many  ounces  of  the 
beverage  contain  about  one  ounce  of  alcohol.  The 
largest  quantity  of  alcohol  which  can  be  taken  per 
diem  without  evident  ill  effects  is,  according  to  Dr. 
Parkes,  ijoz. 

From  our  table  we  see  that  i  ounce  v/ould  be  contained 
in  about  4  or  5  ounces  of  port  or  sherry,  and  from  6  to 
10  ounces  of  claret  or  hock,  and  12  to  20  of  ale  or  stout. 
The  varying  size  of  wine-glasses  renders  any  certain  state- 
ment as  to  the  number  of  glasses  which  make  up  this 
amount  impossible ;  but  two  glasses  of  port  or  sherry,  or 
two  or  three  glasses  of  claret,  represent  it  pretty  nearly. 
Half  a  pint  of  Burton  ale,  or  a  pint  of  ordinary  ale,  would 
nearly  contain  it.  Some  of  the  lighter  ales  and  common 
porter  contain  much  less.  Hence,  for  i  ^  ounce  of  alcohol, 
we  may  reckon  three  or  four  glasses  of  port  or  sherry ; 
three  to  five  of  claret ;  two  glasses  of  Burton  ale ;  one  and 


figures  given  by  different  authorities.  The  amount  is  here  given  by 
volufne,  not  by  weight.  It  is  idle  to  give  decimals  when  the  per- 
centage  is  so  variable.  For  other  tables  showing  the  analysis  of  a 
large  number  of  wines,  &c.,  and  for  more  accurate  calculations,  see 
Thudichum  and  Dupre  ('Origin,  Nature,  and  Use  of  Wines,'  i872)t 


alcohol:  its  use  and  abuse.  13 

a  half  to  two  pints  of  common  ale ;  and  perhaps  two  to 
three  pints  of  the  very  weakest  ale.  But  we  must  bear 
in  mind  that  this  is  the  outside  hmit,  and  represents  the 
quantity  which  just  fails  to  produce  any  obvious  diminu- 
tion of  work  in  healthy  men ;  whether  it  does  not  cause 
some  deterioration  of  the  organs  is  another  question. 

But  it  is  not  merely  the  amount  of  alcohol  which  is 
important;  its  action  is  partly  controlled  by  its  state  of 
combination.  A  pint  of  brandy-and-water,  of  such 
strength  as  to  contain  only  as  much  alcohol  as  a  pint  of 
beer,  will  yet  act  somewhat  differently;  and  there  are 
other  substances  in  beers  and  wines  which  variously  in- 
fluence both  nutrition  and  digestion. 

The  composition  and  special  properties  of  some  of 
these  may  with  advantage  be  briefly  reviewed. 

Beer. — An  average  sample  of  beer  contains  in  20  ounces 
(i  pint)— 

Alcohol I      oz. 

Extractives,  dextrine,  and  sugar     .      .     1*2  ,,  (524  grains) 

Free   acid    (lactic,    acetic,    gallic,    and 

malic  acid) 25  grains. 

Salts  (alkaline  chlorides  and  phos- 
phates)          13       ,» 

Carbonic  acid  and  volatile  and  essential 
oils. 

Porter  contains  caramel  (burnt  sugar),  and  usually  more 
dextrine  and  sugar  than  ale. 


14  ALCOHOL  :  ITS  USE  AND  ABUSE. 

Sj>edal  action  of  Beers. — According  to  Dr.  Parkes,  the 
special  physiological  action  of  beer  is  to  lessen  the  excre- 
tion (removal  by  the  organs)  of  the  products  of  tissue 
change,  both  urea,  the  waste  nitrogen  product  carried  off 
by  the  kidneys,  and  carbonic  acid,  the  waste  carbon  pro- 
duct given  off  from  the  lungs.  This  action  is  not  due  to 
the  alcohol  contained,  but  to  some  other  substance. 

A  daily  excess  of  beer,  as  all  know,  leads  to  a  state  of 
fulness  and  plethora,  and  a  great  accumulation  of  fat. 
This  is  partly  due  to  a  check  in  the  proper  nutritive 
changes  in  the  tissues,  partly  to  increased  supply  of  fat- 
forming  substances.  The  waste  products  are  imperfectly 
burnt  off,  and  accumulate  in  the  system,  giving  rise  to 
gouty  and  bilious  disorders. 

The  use  of  beer  in  moderation  answers  several  pur- 
poses besides  the  action  of  the  alcohol :  it  supplies  sub- 
stances which  are  nutrient  and  fat-forming,  and  lessens 
the  destruction  of  fat,  and  thus  increases  the  weight  of 
the  body.  The  free  acids  and  the  bitter  extractive 
matters,  which  are  chiefly  derived  from  the  hops,  are 
useful  as  stomachic  tonics  and  serve  to  promote  di- 
gestion. The  salts  also  assist  in  nutrition,  though  in 
what  manner  we  do  not  know.  In  moderation,  there- 
fore, beer  is  undoubtedly  useful  to  many. 

Wines. — Wines,  as  we  have  said,  vary  very  greatly  in 
their  composition,  and  so  widely,  that  we  could  not  give 


ALCOHOL  :    ITS   USE   AND   ABUSE.  1 5 

even  the  average  composition  of  any  one  sort  of  wine  to 
serve  any  useful  purpose. 

Wines  alter  much  by  keeping ;  they  undergo  important 
chemical  changes.  Red  wines  contain  a  good  deal  of 
tannin,  derived  from  the  grape-skins ;  this  is  in  great  part 
precipitated  with  some  colouring  matter  ;  and  tartrate  of 
potash  is  also  gradually  precipitated.  Some  of  the  sui^ar 
undergoes  complex  chemical  changes,  and  with  the 
alcohol  forms  ethers,  which  give  bouquet  to  the  wine; 
part  also  of  the  alcohol  is  lost  by  gradual  evaporation. 
Hence  old  wine  is  much  less  rich  in  sugar  and  alcohol, 
and  contains  less  astringent  and  saline  matter  than  young 
and  fruity  wine,  but  more  ethers.  Hence  the  properties 
of  any  given  wine  alter  very  much  with  age. 

Although  the  chemical  constitution  of  the  alcohol  con- 
tained in  wines  is  the  same  as  that  in  spirits,  there  can 
be  no  doubt  that  the  action  is  very  different  from  that  of 
spirits,  as  we  have  already  said.  Tissue  degeneration  is 
much  less  readily  produced  when  the  alcohol  is  thus 
taken. 

The  vegetable  salts  contained  in  wine,  especially  in 
the  natural  light  red  wines,  serve  in  some  cases  a  very 
useful  purpose.  According  to  Dr.  Parkes  they  are  highly 
"  anti-scorbutic,"  that  is,  they  prevent  the  occurrence  of 
scurvy.  Scurvy  is  produced  by  the  want  of  vegetable 
salts,  which,  either  by  fresh  vegetables  or  juice  of  fruits 


l6  ALCOHOL  :    ITS   USE    AND   ABUSE. 

(e.g.,  lime-juice),  must  be  supplied  to  the  body.  "  In  a 
campaign  the  issue  of  red  wines  should  never  be  omitted." 
(Parkes.) 

The  ethers  have  peculiar  rapid  stimulant  qualities,  and 
they  are  believed  to  promote  the  absorption  of  fat  by 
exciting  the  secretion  of  the  J^ancrcas,  one  of  the  organs 
which  manufactures  a  digestive  fluid  which  especially 
acts  upon  fat.  According  to  the  late  Dr.  Anstie,  the 
ethers  are  of  especial  value  as  stimulants  in  diseases  of 
children,  and  to  aged  persons. 

A  great  deal  of  the  difference  in  digestibility  of  wines 
depends  upon  the  quantity  of  sugar  and  free  acids  and 
acid  salts.  The  tannin  also  has  a  peculiar  astringent 
effect,  which  in  some  cases  aids,  in  others  deranges 
digestion. 

It  would  be  easy  to  say  a  great  deal  about  the  effects 
popularly  attributed  to  various  liquors,  and  with  some 
show  of  reason.  Science  certainly  lags  behind  experi- 
ence in  this  matter,  as  in  many  others.  We  know  more  of 
the  effects  of  liquor  upon  disease  and  in  producing  disease 
than  of  some  other  actions.  Gin  and  whisky  have  a 
peculiar  action  upon  the  kidneys  and  skin,  because  they 
contain  certain  substances  in  addition  to  alcohol  which 
act  upon  those  organs ;  pale  brandy  is  more  beneficial  in 
allaying  sickness  than  is  rum ;  rum  fattens  more  than  gin, 
and  the  like.    We  can  at  least  give  plausible  reasons  for 


alcohol:  its  use  and  abuse.  17 

these  facts.  Absinthe  hqueur  gives  rise  to  a  peculiar 
form  of  mania,  and  to  epilepsy,  which  are  accounted  for 
by  the  direct  action  of  the  absinthe.  But  why  is  it  that, 
as  is  asserted  and  maintained,  not  only  by  popular  belief 
but  by  statistics,  that  in  countries  and  districts  in  which 
white  wine  is  produced  and  drunk  there  are  far  more 
crimes  of  violence  under  the  influence  of  liquor  than 
where  red  wine  is  habitually  taken ;  that  natural  white 
wines  have  so  different  an  action  from  red  of  equal 
alcoholic  strength?  And  whence  arises  the  belief,  sup- 
ported we  believe  by  experience,  that  white  wine  is  more 
*'  heating  "  than  red  ?  * 

Nor  have  we  space  to  do  more  than  mention  the  varied 
mental  effects  produced  by  drinking  different  liquors.  It 
is  a  popular  belief  that  authors  who  take  wine  or  spirits 
to  promote  the  flow  of  thought  and  invention,  and  stimu- 
late them  in  their  work,  have  the  mental  product  coloured 
by  the  kind  of  stimulant  they  take.  Poets  have  from 
early   ages    been   charged  with   the   failing  of  drawing 

*  Those  who  make  Alpine  ascents  will  have  noticed  that  steady- 
guides  usually  take  red  wine  to  dr  nk  whilst  on  the  climb,  reserving 
a  bottle  of  white  wine  to  drink  when  the  summit  has  been  reached, 
and  the  party  is  resting  exposed  to  cold  air.  They  maintain  that 
for  warmth  only  is  white  wine  to  be  taken.  Those  interested  in 
practical  experience  should  question  some  of  the  best  Swiss  guides 
as  to  the  different  action  of  wines  and  spirits.  We  have  had  some 
very  interesting  chats  on  the  subject  above  the  snow  line. 


l8  ALCOHOL  :    ITS   USE   AND   ABUSE. 

inspiration  from  wine  ;  and  even  the  divine  Homer  has 
been  called  "Vinosus  Homerus."*  A  hke  charge  has 
been  made  against  many  poets  since ;  in  some  cases,  it 
must  be  feared  with  too  m^ach  truth,  in  the  cases  of  Byron, 
Campbell,  and  Edgar  Allan  Poe,  for  example.  But  we 
have  no  exact  knowledge  of  the  relative  mental  effects  of 
different  stimulants ;  we  point  it  out  only  as  a  subject 
worthy  of  inquiry. 

We  may  postpone  the  consideration  of  the  choice  of  a 
beverage  until  we  have  further  discussed  the  action  of 
alcohol. 


CHAPTER  n. 

THE   PHYSIOLOGICAL  ACTION   OF   ALCOHOL. 

By  this  we  mean  its  action  on  the  body  in  a  state  of 
health — how  it  modifies  the  natural  actions  of  life,  such 
as  the  circulation,  the  power  of  feeling,  movement,  and 

*  ...  Si  credis,  .  .  . 

Nulla  placere  diu,  nee  vivere  carmina  possunt, 
Quae  scribuntur  aquae  potoiibus.  .  .  . 

Laudibus  arguitur  vini  vinosus  Homerus  : 
Ennius  ipse  pater  nunquam  nisi  potus  ad  arma 
Prosiluit  dicenda. 

Horace,  Epist.  lib.  i.,  xix.  1-9. 


alcohol:  its  ,use  and  abuse.  19 

«o  on.  And  here  we  must  only  very  briefly  speak  of  some 
of  the  more  important  effects  which  are  observed  by  ex- 
periment. Let  any  one  who  knows  how  many  and  various 
are  the  natural  actions  which  go  on  in  the  body,  consider 
what  a  multitude  of  effects  such  an  agent  as  alcohol  might 
produce  in  different  doses,  and  he  will  see  how  complex 
the  subject  is.  And  we  shall  have  to  mention  a  great 
many  of  these  effects  again  from  time  to  time,  so  need 
not  so  fully  discuss  them  here. 

The  effect  of  alcohol  differs  as  it  is  given  in  a  small 
dose,  a  repetition  of  small  doses,  or  a  large  dose  at  once. 
The  most  important  direct  actions  are  upon  the  circulation 
of  the  blood,  and  upon  the  nervous  system. 

Absorption  of  Alcohol. — When  alcohol  is  taken  in  any 
form  into  the  stomach,  it  is  taken  up  by  the  minute, 
so-called  capillary,  or  hair-like  blood-vessels  which 
ramify  in  ifs~sfructure ;  from  them  it  gets  into  the  larger 
,  vessels  or  veins,  and  is  conveyed  to  the  heart.  The 
"heart,  as  most  people  know,  is  the  hollow  muscular  organ 
which  propels  the  blood  through  the  body.  It  is  divided 
into  two  halves,  and  each  of  these  again  consists  of  two 
cavities  or  chambers,  one  of  which,  the  auricle^  first  re- 
ceives the  blood,  which  then  passes  into  the  Dentride^ 
which  propels  it  into  the  arteries.  The  blood  which 
comes  from  the  veins  of  the  body  goes  into  the  right 
auricle,  and  is  sent  on  by  the  right  ventricle  into  the 


to  alcohol:  its  use  and  abuse. 

lungs,  where  It  passes  through  a  network  of  capillary 
vessels  in  contact  with  the  air,  and  is  so  purified,  then  it 
goes  back  to  the  left  side  of  the  heart,  which  sends  it 
into  the  arteries  of  the  body  to  do  its  work  again.  But 
all  the  blood  which  goes  from  the  stomach  passes  first 
to  the  liver,  which  is  interposed  as  a  sort  of  sieve  be- 
tween the  stomach  and  the  heart.  The  minute  vessels 
of  the  stomach  unite  into  one  large  trunk,  or  vein, 
which  joins  the  veins  from  the  bowels ;  and  when  it 
reaches  the  liver  breaks  up  again  into  an  infinity  of  small 
branches,  which  ramify  through  the  liver,  and  join  again 
into  one  large  trunk  vessel,  which  carries  the  blood  to  the 
right  side  of  the  heart. 

So  tteij^rjl  the  alcohol  which  we  drink,  after  becoming 
diluted  with  water,  is  absorbed  by  the  blood,  carried  to 
the  liver,  thence  to  the  heart,  then  the  lungs,  back  to  the 
heart  again,  and  is  distributed  from  it  to  all  parts  of  the 
body.  If  the  alcohol  is  injected  into  the  veins,  it  makes 
its  way  straight  to  the  right  side  of  the  heart  without  going 
through  the  liver ;  if  inhaled  into  the  lungs  as  vapour,  it  is 
carried  straight  to  the  left  side  of  the  heart.  But  even 
when  it  takes  the  roundabout  course  through  the  liver  to 
heart  and  lungs  before  it  gets  into  the  general  blood-stream, 
it  passes  through  in  a  very  short  time — not  more  than  a 
minute  or  two — and  its  general  effects  are  very  rapidly 
produced.     The  absorption  from  the  stomach  continues 


alcohol:  its  use  and  abuse.  21 

as  long  as  any  more  alcohol  is  present  there,  and  its  rate 
of  absorption  is  modified  by  various  conditions. 

Alcohol,  as  such,  cannot  be  taken  up  directly  by  the 
vessels,  but  must  first  be  diluted  with  water  in  order  to 
pass  through  their  walls.  Now  when  we  take  anything, 
especially  solid  food,  into  the  stomach,  one  of  the  first 
effects  is  to  produce  a  fulness  of  the  blood-vessels  of  the 
lining  or  "  mucous  membrane"  of  that  organ,  and  then  from 
it  is  poured  out  fluid  which  mixes  with  the  food  taken, 
and  "digests"  it,  that  is,  fits  it  for  absorption.  The 
mucous  membrane  is  provided  with  many  organs  called 
glands,  which  make  various  substances  which  act  chemi- 
cally upon  the  food,  and  are  mingled  with  the  watery 
fluid  poured  out  by  the  vessels.  The  quantity  and  quality 
of  these  constituents  of  the  "  gastric  juice,"  or  digesting 
fluid,  are  beautifully  regulated  in  their  supply  by  the 
nature  of  the  substance  taken  into  the  stomach.  If 
nothing  but  a  liquid,  such  as  wine  or  brandy,  is  taken, 
very  little  but  water  is  poured  out,  the  effect  being  much 
like  that  of  touching  the  eye  and  making  it  water ;  this 
mixes  with  the  wine,  and  when  properly  diluted,  the 
combined  fluid  is  taken  up  by  the  blood-vessels. 

But  if  we  take  wine  with  food,  the  solid  food  is 
mixed  with  it,  and,  moreover,  a  much  larger  quantity  of 
fluid  is  poured  out  by  the  stomach  wall  into  its  own 
cavity,   owing   to   the   presence    of   the    food,    so   that 


82         ALCOHOL  :  ITS  USE  AND  ABUSE. 

the  absorption  of  the  wine  is  more  gradual  and  it 
becomes  more  diluted. 

If  we  could  look  into  the  stomach  just  after  taking  a 
glass  of  wine,  we  should  see  that  its  inner  surface  became 
bright  red  where  the  wine  touched  it — in  fact,  blushed 
as  it  were.  The  same  would  be  the  case  if  a  piece  of 
meat  were  taken,  but  the  colour  would  probably  be  less 
intense,  and  less  rapidly  produced.  We  shall  see  that 
this  effect  of  alcohol  is  one  which  is  widespread  and  very 
important.  So  far  it  acts  merely  as  an  irritant,  by 
coming  in  contact  with  the  mucous  membrane,  just  as,  if 
we  dropped  it  into  the  eye,  it  would  make  it  red  and 
watery  j  but  when  it  gets  into  the  blood,  it  produces  a 
similar  effect  in  a  different  way. 

The  mixture  with  food,  then,  makes  the  absorption 
slower,  and  so  does  mixture  with  water ;  for  clearly,  there 
is  a  greater  quantity  of  fluid  to  be  taken  up,  and  it  needs 
a  longer  time,  and  less  is  taken  up  in  a  given  time.  The 
combination  of  the  alcohol  also  makes  a  considerable 
difference ;  in  the  form  of  spirits  and  water  it  is  most 
readily  diffused  into  the  blood,  and  acts  most  rapidly ; 
next  as  wine,  and  slowest  as  malt  liquor.  One  apparent 
exception  must  be  noticed.  If  raw  spirits  are  taken  in 
any  considerable  quantity,  no  effect  whatever  may  be 
observed  for  some  little  time.  Many  cases  are  on  record 
where  men  for  a  wager,  or  in  a  drunken  frolic,  have  drunk 


alcohol:  its  use  and  abuse.  23 

a  bottle  of  spirits.  The  effect  may  be,  often  is,  sudden 
death ;  but  it  may  be  that  for  a  quarter  or  half  ?.n  liour 
nothing  happens;  then  sudden  unconsciousness,  going 
on  to  a  condition  of  stupor,  sets  in,  and  speedy  death 
occurs.  This  peculiar  effect  seems  to  be  due  to  a  sort  of 
paralysis  of  the  stomach,  which  takes  some  liitle  time  to 
recover  its  natural  function  of  absorption. 
/    Effect  on  the  Circulation. — If  any  sufficient  quantity  of 

... Yialcohol  is  taken,  we  see  a  more  marked  effect.      The 
/  face  flushes,  the  skin  seems  warmer ;  there  is  a  sense  of 

^ — being  warmer.))  How  is  this  explained?  We  know  that 
all  parts  of  the  body  are  abundantly  supplied  with 
blood-vessels,  the  smallest  of  which,  called  capillaries, 
make  up  a  great  part  of  the  textures.  Every  beat  of 
the  heart  drives  blood  through  these  networks  of  minute 
vessels,  and  the  quantity  thus  supplied  depends,  of 
course,  partly  upon  the  force  of  the  heart  and  the  fre- 
quency of  the  pulse.  But  the  arteries,  or  vessels  which 
carry  the  blood  from  the  heart  to  the  capillaries,  are  not 
rigid  tubes  ;  they  are  elastic,  and  they  also  are  muscular, 
and  can  alter  their  size  in  accordance  with  the  needs  of 
the  part  they  supply.  We  regulate  the  quantity  of  gas 
we  burn  in  several  ways  :  we  may  control  it  either  at  the 
metre,  or  on  its  way  to  the  lamp,  or  at  the  lamp  itself  by 
the  tap  ;  and  the  Gas  Company,  too,  can  give  it  greater 
or  less  pressure,  or  check  our  supply  at  the  main.     Now, 


84  ALCOHOL  :  ITS  USE  AND  ABUSE. 

if  instead  of  thus  having  several  taps  or  stop-cocks  at  inter- 
vals along  onr  system  of  gas-pipes,  we  could  arrange  for  the 
pipes  to  be  narrowed  at  pleasure  in  their  whole  length,  so 
as  to  make  the  channel  smaller  when  we  wanted  less 
gas,  and  to  dilate  and  get  larger  when  we  wanted  more, 
we  should  have  the  same  arrangement  which  is  found  in 
the  blood-vessels.  Suppose,  too,  that  for  the  words  "  ner- 
vous system  "  we  substituted  "gas-engineer";  for  "heart," 
"central  gas-works,"  and  for  "arteries,"  "gas-pipes," 
and  understood  that  the  gas-engineer  could,  by  means  of 
electric  wires,  control  the  size  of  our  gas-pipes,  we  should 
have  a  rough  simile  of  the  arrangement  of  our  vessels. 
We  must  imagine  also  that  the  householder  has  the  power 
of  controlling  his  gas-pipes  as  well  as  the  engineer.  The 
arteries,  even  to  their  most  minute  branches,  or  arterioles^ 
have  this  property  of  contracting  and  dilating,  and  they 
do  this  either  in  response  to  a  central  order  conveyed  by 
nerves,  or  in  consequence  of  a  local  action  upon  their 
nerves,  or  their  muscular  coats.  Alcohol  has  a  very  marked 
power  of  thus  causing  the  vessels  to  dilate  whenever  it  is 
contained  in  the  blood,  so  that  these  minute  vessels  be- 
come turgid,  and  the  tissue  redder.  At  the  same  time  it 
acts  upon  the  heart  also.  The  contraction  of  the  heart 
has  to  overcome  the  resistance  of  the  vessels,  and  to  keep 
them  full  of  blood.  When  the  vessels  dilate,  they  offer 
less  resistance  to  the  heart,  and  moreover,  the  whole  mass 


ALCOHOL  :   ITS   USE    AND   ABUSE.  25 

of  blood  in  them  in  the  part  is  of  necessity  greater.  To 
keep  them  full  the  heart  must  send  more  blood  at  a  time 
in  each  pulse,  or  the  pulses  must  more  quickly  follow 
one  another. 

But  alcohol  acts  also  on  the  heart  itself,  and  makes  it 
/  beat  faster,  and  propel  more  blood  in  a  given  time. 
"/"  Thus  we  see  that  the  one  early  result  of  alcohol  is  to 
(  produce  dilatation  of  the  blood-vessels,  both  local  and 
general,  to  quicken  the  action  of  the  heart,  and  make  it 
do  more  work  in  a  given  time.  This  latter  action  has 
been  carefully  studied  by  experiment.  We  may  quote 
here  the  remarks  of  the  late  Dr.  Parkes,  who  made  many 
careful  observations  on  this  pointj^  'f^AIcohol  in  healthy 
persons  at  first  increases  the  force  and  quickness  of  the 
heart's  action^/  In  a  healthy  man  I  found  that  brandy 
augmented  the  rapidity  of  the  pulse  13  per  cent.,  and  the 
force  was  also  increased ;  taking  the  usual  estimate  of 
the  heart's  work,  its  daily  excess  of  work  with  4*8  fluid 
ounces  of  absolute  alcohol  was  equal  to  15*8  tons  lifted 
one  foot.  With  claret  the  results  were  almost  identical." 
Dr.  Parkes  adds  the  important  statement :  "  the  period 
of  rest  of  the  heart  was  shortened,  and  its  nutrition  must 
therefore  have  been  interfered  with."  But  in  smaller 
quantities  it  seems  that  the  action  of  the  heart  may  be 
increased,  and  yet  its  nutrition  be  maintained. 

If  this  action  on  the  heart  and  blood-vessels  is  only 


26  alcohol:  its  use  and  abuse. 

temporary  the  effects  are  probably  not  permanent ;  but  if 
kept  up  day  after  day,  year  after  year,  they  lead  to  changes 
in  the  structure  and  action  of  the  system,  of  which  we 
shall  speak  later. 

On  the  Nerzwiis  Systcfji. — Alcohol  acts  on  the  brain, 
the  spinal  cord,  and  the  nerves  when  conveyed  to  them 
by  the  blood.  It  not  only  affects  their  function  by  pro- 
ducing quickened  circulation  through  them,  but  it  acts 
also  upon  their  own  proper  structural  elements.  .  Its 
main  action  seems  to  be  to  lower  the  proper  activity  of 
the  nervous  matter.  This  is  composed  of  cells  and 
fibres ;  the  former,  which  are  chiefly  in  the  brain  and 
spinal  cord,  originate  and  receive  nervous  impulses ;  the 
latter  convey  them  to  and  fro.  Alcohol  appears  to 
have  a  special  affinity  for  the  substance  composing  these 
cells  and  fibres,  and  endowed  widi  these  peculiar 
nervous  properties,  and  its  effect  is  to  diminish  their 
activity,  so  that  the  cells  originate  and  receive  im- 
pulses more  sluggishly,  and  the  fibres  conduct  them  less 
perfectly.* 

♦  This,  at  least,  is  the  view  which  our  present  knowledj^'e  indi- 
cates. According  to  some,  the  action  of  alcohol  at  first,  or  in  moderate 
quantities,  "is  simply  to  augment  the  generation  of  nervous  power. 
When  this  increased  action  of  the  nervous  system  is  kept  within 
certain  limits  the  effect  of  the  alcohol  is  beneficial ;  but  when  carried 
beyond  a  certain  point  the  action  is  injurious  and  deteriorating,  the 
sf  irit  at  length  impairing  and  ultimately  destroying  the  nutrition  of 


alcohol:  its  use  and  abuse.  27 

How  is  this  effected?  It  used  to  be  stated  that 
alcohol  was  especially  absorbed  and  retained  by  the 
brain  substance,  and  could  be  found  in  combination 
with  it  in  drinkers  after  it  had  been  removed  from 
the  rest  of  the  body;  but  this  is  now  shown  to  be  an  I 
error.  But  whether  we  suppose  that  it  actually  combines 
with  the  nervous  matter,  or  only  acts  upon  it  by  its 
presence  as  a  sort  of  damper,  we  can  have  no  doubt 
about  its  action.  When  we  come  to  mention  the  effects 
of  alcohol,  as  shown  by  the  various  mental  and  nervous 
symptoms  which  result  from  its  misuse,  we  shall  see  a 
combination  of  the  effects  of  vascular  excitement  and 
nervous  weakening,  and  shall  be  able  to  trace  a  regular 
course  in  them.  We  shall  find  that  at  first  there  is  for  a 
time  apparent  overaction  or  excitement  of  the  brain  and  * 
nervous  system,  due,  in  part,  to  increased  blood-supply^ 
and  rapid  circulation  ;  in  part,  it  may  be,  to  direct  stimu- 
lation of  the  nerve  cells.  Then  as  the  effect  is  main- 
tained or  increased  we  shall  see  diminished  activity.  The 
higher  functions  of  thought,  will,  and  consciousness  be- 
come impaired ;  the  power  of  action,  especially  of  con- 
trolled and  balanced  action,  lessened ;  sense  and  feeling 


the  nervous  matter"  (Todd).  But  it  is  a  question  whether  more 
force  is  generated  or  is  only  set  free  at  first,  the  latter  being  the 
view  now  more  commonly  held. 


28  ALCOHOL  :  ITS  USE  AND  ABUSE. 

are  diminished;  and,  at  last,  unconsciousness  and  inaction 
results.  We  might  trace  all  these  out  in  detail,  and 
see  how  the  alcohol  acting  upon  the  brain  in  its  various 
parts,  upon  the  spinal  marrow  and  upon  the  nerves, 
produces  these  varied  effects,  which  all  result  from 
diminished  action  due  to  the  presence  of  alcohol.  If 
consciousness  is  the  faculty  of  the  part  of  the  nervous 
system  affected,  this  gives  place  first  to  lessened  and 
then  to  lost  consciousness ;  if  feeling,  it  is  first  deadened, 
then  lost ;  if  motion,  it  is  first  irregular,  then  defective, 
then  more  or  less  entirely  lost. 

As  a  general  rule,  in  man  at  any  rate,  these  powers 
or  functions  of  the  nervous  system  are  affected  in  a 
definite  order,  first  the  higher  powers  of  the  brain  and 
then  the  spinal  centres ;  but  the  extent  to  which  they 
are  affected  varies  in  different  cases,  and  as  both  are 
affected  together,  the  continued  action  may  show  itself 
most  clearly  first  on  one  or  the  other.  That  is  to  say, 
some  men  will  continue  pretty  clear-headed  even  when 
their  gait  has  become  unsteady ;  whilst  others  will  become 
drowsy  or  half  unconscious  before  they  show  any  marked 
want  of  equilibrium.  In  animals  the  casfe  is  rather  dif- 
ferent, and  the  effect  of  a  large  dose  of  alcohol  on  dogs  is 
nearly  always  to  produce  at  first  paralysis  of  the  hind  legs, 
showing  that  the  spinal  cord  towards  its  lower  part  is  ia 
them  the  first  to  give  way. 


ALCOHOL  :    ITS    USE    AND    ABUSE.  29 

The  influence,  not  only  of  habit  and  constitution,  but 
of  disease  or  idiosyncracy,  may  also  greatly  determine 
the  part  of  the  nervous  system  which  is  chiefly  affected. 
Great  pain  may  keep  up  such  a  condition  of  excitement 
of  the  brain  that  the  power  of  alcohol  in  producing  un- 
consciousness is  nearly  lost.  So,  too,  may  mental  excite- 
ment or  emotion,  or  mental  derangement ;  and  it  is  from 
this  cause  that  the  great  danger  of  alcohol  to  some 
persons  arises.  They  can  take  a  large  quantity  of  alcohol 
for  some  time  with  little  perceptible  effect  upon  the  brain. 
Then  comes  a  time  when  the  power  of  resistance  is  gone, 
and  the  brain  suddenly  gives  way,  delirium  tremens,  in 
some  of  the  fiercest  and  strangest  forms,  resulting.  So 
that  this  production  of  unconsciousness,  which  is  so  great 
a  safeguard  against  dangerous  results,  cannot  always  be 
relied  upon.  We  have  seen  cases  of  men  who  showed  none 
of  the  ordinary  signs  of  excess  in  drink,  or  at  least  so  slight 
as  to  be  almost  imperceptible,  or  perhaps  slightly  tremu- 
lous and  unable  to  walk,  suddenly  burst  out  into  the  most 
violent  raving  delirium  with  fury.  In  two  such  cases  we 
have  seen  hospital  patients  who  for  two  days  had  been 
in  hospital  and  not  taken  any  spirits,  and  had  been 
admitted  for  indigestion  with  weakness  in  the  legs,  who 
were  apparently  perfectly  rational  and  calm,  go  off  sud- 
denly into  this  violent  frenzied  delirium ;  and  it  was  not 
till  afterwards  that  the  discovery  was  made  that  in  both 


30  alcohol:  its  use  and  abuse. 

cases  a  long  and  deep  debauch  had  immediately  preceded 
the  symptoms  for  which  they  sought  admission  to  the 
hospital.  Here  the  alcohol  had  been  acting,  but  held  in 
check;  the  deranged  working  of  the  nervous  centres, 
produced  by  the  opposing  actions,  resulted  in  the  violent 
explosion  of  the  pent-up  forces. 

Weakening,  deranged  action  and  paralysis  of  volition, 
sensation  and  motion,  are  thus  seen  to  be  the  results  of 
alcohol  acting  upon  the  nervous  system. 

These  effects  of  alcohol  on  the  circulatory  and  nervous 
systems  are  the  most  important  for  our  present  purpose, 
and  they  explain  many  of  the  other  effects  to  which  we 
cannot  here  allude,  but  which  depend  on  disturbed  action 
of  various  organs.  Probably  all  tissues  which  have  vital 
properties  may  be  more  or  less  affected  by  alcohol,  and 
the  changes  connected  with  their  nutrition  and  functions 
impaired  ;  but  the  experiments  hitherto  made  on  these 
points  are  conflicting. 

So  also  are  the  results  as  to  the  prevention  of  waste  of 
the  tissues,  and  the  accumulation  of  fat,  by  the  use  of 
alcohol.  Strong  ground  is  afforded  by  what  we  see  in 
the  use  of  alcohol  in  disease  for  the  belief  that  it  has 
some  such  action,  but  how  it  acts  we  hardly  know  as  yet ; 
and  such  an  action  in  health  has  been  doubted,  so  that 
we  will  only  mention  this  without  discussing  it. 

It  has  been  affirmed  by  some,  and  denied  by  others, 


alcohol:  its  use  and  abuse.  31 

that  alcohol  lowers  the  temperature  of  the  body.  In 
moderate  quantities  it  scarcely  seems  to  affect  it;  in 
larger  doses,  it  lowers  it  slightly  in  some  cases ;  in 
poisonous  doses  the  body  is  greatly  cooled.  We  shall 
speak  of  this  later. 

What  becomes  of  the  alcoliol  taken  into  the  body? 
Some  have  believed  that  it  all  enters  into  combination 
with  the  tissues,  and  after  a  time  is  all  carried  away  out 
of  the  body  by  the  natural  channels.  This  is  no  doubt 
an  error.  Only  a  small  portion  gets  out  of  the  body  as 
alcohol ;  the  greater  part,  and  nearly  all  if  the  quantity  is 
not  excessive,  is  used  up — burnt,  so  to  speak — in  the 
body,  and  thus  gives  some  small  amount  of  nutriment, 
A  very  small  quantity  is  carried  off  by  the  lungs  and 
kidneys,  unless  a  larger  amount  is  taken  than  can  be  used 
up,  when  the  excess  is  thus  discharged. 

We  shall  see  presently  that  the  fact  that  alcohol  is 
eliminated  by  the  kidneys  is  important  as  explaining  its 
special  effect  in  producing  disease  of  those  organs ;  just 
as  the  passage  of  all  the  alcohol  from  the  stomach 
through  the  liver  explains  the  frequent  disease  of  the 
latter  organ  in  drinkers. 

We  cannot  go  further  into  detail  upon  this  subject ; 
indeed,  there  is  yet  much  obscurity  upon  the  action  of 
alcohol  in  the  system.  We  have  said  enough  to  serve  as 
a  guide  to  what  we  have  to  sa^  as  to  its  use. 


32  ALCOHOL  :  ITS  USE  AND  ABUSE. 

CHAPTER  III. 

THE    EFFECTS   OF   ALCOHOL   WHEN   TAKEN    IN    EXCESS. 

We  have  seen  that  the  first  tangible  result  of  taking  any 
form  of  alcoholic  beverage,  so  far  as  it  reveals  itself  to 
our  consciousness,  is  a  slight  stimulant  effect.  A  glow  of 
warmth  is  diffused  over  the  body ;  there  is  a  sensation  of 
pleasure,  which  takes  its  special  colour  from  the  surround- 
ings of  the  moment,  showing  itself  in  relief  from  discom- 
fort, whether  mental  or  physical,  in  increased  enjoyment 
of  the  flow  of  conversation,  in  a  freer  current  of  thought 
and  social  intercourse,  or  any  of  the  other  subtle  harmo- 
nies of  life.  It  may  be  objected  that  such  is  not  always 
the  effect ;  that  it  is  largely  modified  by  habit,  by  the 
condition  of  digestion,  the  drink  taken,  and  the  special 
temperament  and  constitution  of  the  individual ;  and  we 
fully  admit  this  objection.  But,  allowing  for  all  such  dif- 
ferences in  degree,  such  is  the  most  common  sensible 
effect  of  the  "  wine  which  maketh  glad  the  heart  of  man." 
But  if  more  than  a  certain  quantity  is  taken,  further 
results  rapidly  ensue.  The  point  of  stimulation  only 
may  be  reached  by  a  continuance  of  repeated  small 
doses ;  as,  for  example,  in  a  long  after-dinner  talk,  only 
just  enough  being  taken  to  keep  up  this  stage  :  but  it  is 
easy  to  go  beyond  this  point,  when  other  effects  appear. 


alcohol:  its  use  and  abuse.  33 

Thought  no  longer  only  flows  more  freely  and  conver- 
sation more  pleasantly ;  there  is  some  loss  of  control  of 
thought,  the  ideas  fleet  rapidly,  but  are  not  steadily  re- 
tained, the  too  rapid  stream  overflows  its  banks,  and  is 
broken  into  eddies  and  currents  in  its  course,  so  that  there 
arise  confusion  of  thought,  want  of  clearness  of  apprehen- 
sion, and  inability  to  reason  soundly  and  consecutively. 
Nor  is  the  intellect  alone  perturbed ;  the  emotions  are 
less  under  control :  mirth  gives  way  to  hilarity,  and  this 
to  boisterous  merriment,  which  may  subside  into  the 
opposite  of  sullennoss,  or  go  on  to  wild  excitement ; 
moral  control  is  lost,  and  the  actions  are  the  result  of 
fitful  caprice,  or  the  outcome  of  baser  passions.  The 
voluntary  and  involuntary  motions  of  the  body  show  a 
like  want  of  control ;  the  more  delicate  movements,  those 
which  require  long-trained  and  adjusted  co-operation  of 
nerve  centres  and  groups  of  muscles,  cannot  be  per- 
formed ;  even  those  which  are  so  far  habitual  and  auto- 
matic that  we  can  perform  them  without  conscious 
efl"ort,  and  may  even  do  them  during  sleep,  become 
difficult  or  are  done  imperfectly.  It  is  well  known  that 
many  actions,  such  as  walking,  are  done  almost  without 
volition  when  the  power  has  been  acquired,  so  that  we 
only  will  to  go  to  such-and-such  a  place,  or  to  walk 
about,  and  our  attention,  so  long  as  all  goes  well,  is  no 
longer  needful.     We   balance  the  body,  throw  out  one 


34  ALCOHOL  :  ITS  USE  AND  ABUSE. 

foot,  poise  ourselves  on  the  other,  plant  the  foot,  and 
so  on,  without  the  least  consciousness  that  we  are  doing 
so ;  though,  should  any  accident  derange  some  part  of 
the  mechanism,  we  are  painfully  alive  to  the  various 
movements.  Other  habitual  actions  require  a  greater 
control  and  attention,  yet  may  become  almost  equally 
automatic  as  walking.  There  are  many  men  who  write 
constantly  or  much,  who  become  equally  facile ;  there 
is  to  them  no  conscious  pause  or  thought  between  the 
volition  to  write,  and  the  appearance  of  the  word  on 
the  paper ;  and  so  established  is  the  connexion  of  thought 
and  word,  that  for  each  idea  there  is  a  sign  which 
they  place  upon  paper,  and  the  sign  may  be  one  which 
they  have  adopted  for  brevity  of  expression,  but  which 
they  use  as  their  token  for  the  thought  or  word  quite 
unconsciously,  and  require  great  effort  not  to  use.  We 
might  thus  instance  also  other  acquired  movements,  such 
as  playing  musical  instruments,  knitting,  and  working 
various  machines,  which  by  habit  become  capable  of 
execution  almost  unconsciously.  It  is  these  movements 
Which  first  show  that  disorder  which  results  from  loss  of 
control.  There  may  be  perfect  consciousness  of  the 
right  method  of  doing  them,  and  an  endeavour  to  do 
them,  but  they  are  less  delicately  combined,  need  greater 
effort  for  their  performance,  and  when  a  certain  point 
of  intoxication  has  been   reached,  they  are   either   im- 


ALCOHOL  :    ITS    USE    AND    ABUSE.  35 

possible  if  very  complex,  or  are  done  clumsily  and  ir- 
regularly. It  is  thus  the  movements  which  are  acquired 
with  most  pains,  such  as  writing  and  mechanical  move- 
ments, which  are  first  disordered;  then  those  which, 
though  complex,  like  walking,  are  not  the  outcome  of 
great  training  and  effort,  yet  require  regularly  co-ordinated 
action  for  their  performance.  On  a  rather  different  level 
we  may  place  the  act  of  speech,  one  of  the  most 
thoroughly  acquired  yet  most  complex  of  our  actions. 
It  would  be  interesting  to  study  in  detail  the  mode  in 
which  this  is  affected,  and  to  show  how  the  derange- 
ments of  the  several  groups  of  nervous  centres  cause  a 
variety  of  changes  in  its  performance.  We  must  only 
just  mention  them  in  passing.  To  speak  a  word,  we 
must  first  in  some  way  have  the  idea  of  the  word  in 
the  mind,  or  rather  a  word-idea  is  our  mental  cheque 
or  telegraph-form  for  the  word.  This  word-idea  must 
pass  to  the  nerve-centre  which  controls  the  expression, 
from  which  again  all  the  orders,  or  stimuli,  to  the 
centres  which  control  each  part  of  the  speaking  of  the 
word  must  pass ;  and  these  orders,  in  the  transmission, 
must  be  harmonised  so  that  they  may  produce  not 
merely  the  sounds  needed,  but  the  sounds  in  their  due 
order,  force,  and  inflection.  There  are  required  for  each 
word  which  we  speak,  special  movements  of  the  tongue, 
mouth,   palate,  and  throat,    organised  and  united  into 


36  ALCOHOL  :    ITS   USE   AND   ABUSE. 

one,  and  all  controlled  by  separate  and  numerous 
centres,  and  the  defective  adjustment  of  any  one  of 
these  deranges  and  spoils  the  speaking  of  the  word. 
But  in  speech  it  is  not  one  word,  but  a  continuous 
flow  of  words  that  we  employ,  all  separate,  yet  all 
harmonised  and  succeeding  each  other  with  a  rapidity 
which  seems  to  leave  no  time  for  special  arranging  of 
the  organs.  When,  therefore,  control  is  less  active,  the 
reins  slackened  so  to  speak,  words  may  be  wrongly 
spoken  through  the  wrong  word-idea  being  chos"en ;  or 
they  may  be  omitted,  or  curtailed,  or  misplaced ;  or 
they  may  be  imperfectly  made  up,  lacking  some  parts, 
or  jumbled  together  in  confused  expression ;  and  the  dis- 
order of  the  uttering  organs  of  speech  may  cause  them 
to  be  dipt  at  the  ends,  stammered,  or  mouthed,  or  "  thick  " 
from  defective  action  of  the  tongue.  Thus  we  might 
see  how  the  loss  of  control  of  idea  at  the  one  terminal, 
causes  confusion  of  thought  and  wrong  choice  of  words, 
and  at  the  other,  how  the  organs  of  expression  fail 
from  maladaptation,  and  we  might  try  to  show  how  all 
the  degrees  of  speech-affection  are  indices  of  stages  of 
intoxication. 

In  a  yet  further  stage  of  intoxication,  we  find  that 
movements  which  are  naturally  combined  in  harmony, 
and  which  we  cannot  derange  without  voluntary  effort, 
become  deranged ;   this  especially  in  the  case  of  actions 


ALCOHOL  :    ITS   USE   AND   ABUSE.  37 

which,  hke  those  of  the  eyes,  are  symmetrical  for  two 
corresponding  organs.  In  healthy  eyes,  the  muscles  which 
move  the  eyeballs,  so  as  to  direct  them  towards  any  given 
object,  or  to  concentrate  them  upon  a  nearer  or  further 
point,  act  automatically,  so  that  the  images  in  the  two 
retinae  fall  on  corresponding  points,  and  are  organised 
into  one  image  in  the  brain.  When,  from  injury  or 
disease,  one  of  the  muscles  is  but  slightly  deranged,  or 
when  we  squint  voluntarily,  the  image  in  one  eye  falls 
upon  a  point  in  the  retina  which  does  not  correspond 
with  that  of  the  other  image,  and  thus  two  images  are 
seen.*  Now  this  derangement  occurs  under  the  influence} 
of  drinking — the  eyes  do  not  move  in  harmony,  hence  the  ,5 
man  "  sees  double."  (We  do  not  mean  to  say  that  this 
is  the  only  way  in  which  intoxication  causes  double 
vision,  for  others  may  and  do  occur,  and  two  images  and 
more  may  be  seen  with  one  eye  ;  but  to  understand  the 
mechanism  of  these,  a  njuch  more  elaborate  account 
of  the  structure  and  actions  of  the  eye  would  be  needed.) 
We  may  here  pause  to  note  that  the  rapidity  with 
which  these  effects  are  produced,  as  well  as  their  cha- 
racter, varies  immensely  with  the  person,  with  the  kind  of 
drink,  the  rate  at  which  it  is  taken,  and  many  other  cir- 
cumstances.    Moreover,  many  of  them  may  be  absent, 

*  For  further  details  on  this  interesting  subject  see  the  work  in 
this  series  on  '  The  Eye.' 


38  alcohol:  its  use  and  abuse. 

and  the  process  may  cease  at  any  point  if  the  drinking 
be  suspended. 

Before  going  further,  we  may  inquire  what  is  the  mode 
of  action  of  alcohol  by  which  these  results  are  produced. 
We  have  spoken  of  excitement,  followed  by  confusion  of 
intellect,  emotion  and  action ;  and  we  shall  see  that  a  yet 
further  stage  may  be  reached  in  which  all  the  powers  are 
in  abeyance  and  dormant,  and  a  living  death,  or  mere 
vegetative  life,  remains.  But  all  these  maybe  summed  up 
in  the  words,  loss  of  control.  The  higher  intellectual 
centres  cease  to  control  the  thought,  the  moral  control  is 
lost  over  the  emotions,  the  centres  which  govern  and  direct 
combined  action  no  longer  guide  the  lower  and  subor- 
dinate ones,  and  they  in  turn  hold  less  in  check  and  tone 
the  muscles  and  their  nerves.  It  would  be  easy  to  show 
that  it  is  not  only  the  higher  powers  which  are  affected, 
that  the  lower  centres,  too,  are  directly  acted  upon.  And 
as  we  have  already  seen  in  speaking  of  the  physio- 
logical action  of  alcohol,  the  earliest  glow  of  warmth, 
flush  of  face,  and  quickened  beat  of  heart,  are  alike  due 
to  a  check  of  control,  so  that  the  minute  blood-vessels 
dilate  owing  to  loss  of  moderating  force. 

For  the  present  we  need  not  carry  into  further  detail 
the  picture  of  the  state  of  the  drunken,  with  which  we 
are  all  too  familiar,  as  it  appears  to  outward  observation ; 
and  the  drunkard  has  himself  no  farther  consciousness 


ALCOHOL  :    ITS    USE   AND   ABUSE.  39 

when  he  has  reached  the  stage  which  we  have  indicated, 
so  that  he  cannot  tell  what  he  feels  or  experiences.  We 
have  touched  upon  this  state  in  speaking  of  physiological 
action.  "  The  worst  estate  of  man  is  that  wherein  he 
loses  the  knowledge  and  government  of  himself." 

If  we  wrote  only  for  those  who,  whether  rarely  or  often, 
drink  to  such  excess  as  this,  we  should  waste  our  labour, 
for  no  such  a.dvice  as  we  could  give,  grounded  on  general 
considerations  of  health,  would  serve  to  deter  them  from 
indulging  their  habits.  We  might  paint  ruin  staring  them 
in  the  face — ruin  of  body,  mind,  and  soul,  or  ply  them 
with  exhortations  to  virtue  and  temperance  ;  but  to  show 
them  their  state  from  a  scientific  point  of  view,  would  be 
like  putting  a  tissue-paper  barrier  to  stop  a  waterfall,  the 
fragments  would  soon  dance  in  the  eddies. 

But  it  is  a  melancholy  fact  that  ?,  very  large  number  of 
those  who  are  permanently  injured  by  drinking  are  of 
those  who  rarely  or  never  drink  beyond  the  stage  of  slight 
excitement,  or  even  halt  before  that  point.  For  one  man 
who  is  injured  by  being  drunk  often,  there  are  twenty  or 
more  who  are  more  seriously  injured  by  drinking  and 
never  approaching  the  verge  of  intoxication.  A  man  may 
drink  in  such  a  way  as  never  to  feel  consciously  excited 
or  embarrassed,  yet  ruin  his  health,  and  cut  short  his 
days  more  speedily  and  surely  than  the  man  who  is  dead- 
drunk  every  Saturday  night. 


40         ALCOHOL  :  ITS  USE  AND  ABUSE. 


^, 


We  may  here  add  a  little  to  what  we  have  already  said 
on  physiological  action,  action,  that  is  to  say,  on  the 
working  of  the  system. 

Every  time  a  machine  is  set  a-going  it  consumes  material 
whicli  sets  it  at  work,  whether  coal  or  gas  ;  it  does  some 
work,  if  only  in  wasted  movement,  and  it  wears  itself 
out  a  little.  It  has  waste  products  in  the  shape  of  ashes 
from  the  coal  or  coke,  and  it  may  be  also  of  the  material 
on  which  it  acts,  and  if  it  wear  itself  rapidly,  as  a  grind- 
stone, for  instance,  there  will  be  the  products  of  its  wear. 
With  one  most  important  qualification  the  human  body 
may  be  likened  to  a  machine,  for  it  is  constantly  at  work; 
its  boilers  need  replenishing,  its  stokehole  filling ;  it  has 
waste  products  both  of  the  fuel  and  of  its  own  wear ;  it 
does  work  of  all  sorts,  and  tends  to  wear  out.  The  dif- 
ference is  that  the  machine  itself  is  a  living  machine  and 
constantly  repairs  and  renews  itself,  though  at  last  its 
power  of  self-repair  fails,  and  it  falls  into  decay. 

Now  it  is  easy  to  see  that,  by  putting  certain  fuel  into 
a  machine,  >ve  may  do  several  things.  The  fuel  may 
make  too  ho't  a  fird,  and  so  over-heat  the  boilers,  dry  up 
the  oil  of  the  bi^ringSj  crack  the  metal,  spoil  the  varnish, 
or  make  the  machine  go  at  a  dangerous  speed.  Or  it 
may  be  corrosive,  and  erode  and  spoil  the  furnace  and 
boilers,  and  perhaps  other  parts.  Or  if  the  machine  be 
a  self-repairing  one,  it  maybe  hindered  from  proper  repair, 


alcohol:  its  use  and  abuse.  41 

whether  by  want  of  clue  supply,  want  of  time,  or  spoiling 
of  the  several  parts. 

Alcohol  may  act  in  all  these  ways  when  taken  in  excess, 
or  in  an  improper  manner,  and  the  results  are  seen  in  the 
various  diseases  which  result  from  its  use.  Even  to  men- 
tion all  these  diseases  by  name  would  require  too  much 
space,  nor,  without  a  description  of  all  the  organs,  could 
we  give  any  adequate  idea  of  them.  The  most  useful 
plan,  we  think,  will  be  to  classify  them  under  three  or 
four  heads ;  to  describe  so  much  of  the  more  common  as 
will  be  of  practical  use,  and  to  mention  only  some  of  the 
rest,  which  come  under  the  more  special  knowledge  of 
the  doctor,  as  follows  : — • 

I.  Comparatively  slight  disorders  due  to  use  of  excess 

of  alcohol,  or  its  use  at  improper  times. 
II.  The  effects  of  large  repeated  doses  in  producing 

simple   intoxication,   or   the   peculiar    forms   of 

alcohol  poisoning  known  as  delirinm  tremens^  &r.c. 
III.  Diseases   resulting    from    the     continued    use    of 

alcohol. 

1.  General  deterioration. 

2.  Destruction  of  special  organs  of  the  body. 
I.  Slight  disorders  due  to  excessive  or  improper  use. 

■ — Returning  to  our  machine,  we  see  that  if  we  use  the 
wrong  fuel  even  once,  we  may  choke  the  flues,  corrode 
the  pipes,  and  so  on,  and  leave  a  certain  result  which  will 


42  ALCOHOL  :    ITS   USE   AND   ABUSE. 

last  only  for  a  time,  if  we  have  it  repaired,  and  cease  to 
use  the  fuel.  If  we  use  it  again  and  again,  we  shall  run 
the  greater  risk  of  damaging  our  machine  irreparably,  so 
that  it  will  always  go  a  little  wrong  or  shakily,  though  it 
may  go  for  a  long  time ;  or  it  may  be  so  damaged  as  to 
break  down  altogether. 

So  we  see  that  wine  or  spirits,  taken  at  wrong  times  or 
in  excess,  cause  disordered  digestion,  constipation,  general 
malaise,  inability  to  work,  nervousness,  shakiness  of  the 
hands,  and  so  on,  with  no  greater  result  if  discontinued  ; 
that  if  taken  once  or  repeatedly  in  large  quantities,  it  may 
cause  drunkenness  or  deliidujn  t7'emens  ;  that  if  taken  for 
months  or  years  in  any  excess,  however  slight,  it  may 
cause  degeneration  or  destruction,  for  all  practical  pur- 
poses, of  certain  parts  of  the  body,  or  a  deterioration  of 
the  whole.  It  is  mainly  the  slighter  forms  that  we  have 
now  to  consider. 

Alcoholic  Indigestion. — One  of  the  commonest,  least 
recognised,  and  most  insidious  results  of  slight  excess  is 
the  derangement  of  digestion  known  as  '''"alcoholic  dys- 
pepsia'' A  multitude  of  well-to-do  and  respectable  people 
suffer  from  it  without  either  knowing  its  cause,  or  being 
aware  that  it  is  preventible,  and  it  is  one  of  the  com- 
monest and  most  troublesome  of  the  complaints  which 
bring  patients  to  the  "  out-patient "  rooms  of  our  hospitals 
(especially  ''chest"  hospitals).     The  symptoms  vary,  but 


alcohol:  its  use  and  abuse.  43 

when  slight  are  something  like  these  :  A  man  (or  woman 
either)  complains  of  slight  loss  of  appetite,  especially  in 
the  morning  for  breakfast ;  feels  languid  either  on  rising 
or  early  in  the  day ;  retches  a  little  in  the  morning,  and 
perhaps  brings  up  a  little  phlegm  only,  or  may  actually 
vomit ;  or  may  be  able  to  take  breakfast,  but  feels  sick 
after  it.  Towards  the  middle  of  the  morning  he  is 
heavy  and  languid,  perhaps,  and  does  not  feel  easy  till  he 
has  had  a  glass  of  sherry  or  some  spirits,  then  gets  on 
pretty  well,  and  can  eat  lunch  or  dinner.  Or  if  worse, 
the  appetite  for  both  is  defective,  and  there  is  undue 
weight  and  discomfort  after  m.eals ;  and  with  this  there 
is  often  some  slight  soreness  of  the  throat,  tickling  sensa- 
tions, and  tendency  to  a  little  cough,  especially  in  the 
morning.  Not  uncommonly  there  is  also  a  tendency  to 
constipation,  and  a  feeling  of  discomfort  and  weight  in 
the  right  side. 

Now  all  these  symptoms  may  be  due  to  other  causes  ; 
but  when  taken  together — and  especially  when  the  loss  of 
appetite  for  breakfast  is  most  marked — they  are  by  far 
most  commonly  due  to  alcohol,  taken  in  excess  or  at 
wrong  times.  They  are,  of  course,  worst  in  those  who 
drink  in  large  excess,  and  there  is  often  then  a  tremulous 
condition  of  the  hands  and  tongue,  and  other  disorders. 
But  many  people  get  into  this  state,  either  occasionally  or 
habitually,  by  taking  a  glass  or  two  of  wine  or  spirits  on 


44  alcohol:  its  use  and  abuse. 

an  empty  stomach  late  at  night;  and  during  the  day,- 
whilst  taking  their  ordinary  stimulant  at  meal-times,  in- 
dulging also  in  a  glass  or  two  of  sherry  in  the  middle  of 
the  morning,  and  perhaps,  too,  at  other  times.  And  we 
must  emphasise  the  statement  that  such  effects  are  often 
seen  in  persons  who  are  abstemious  through  the  day,  and 
moderate  at  dinner,  but  who  take  wine  or  spirits  before 
going  to  bed,  in  order  to  rid  them  of  mental  excitement 
and  enable  them  to  sleep.  So  slight  are  the  other  general 
effects,  that  were  it  not  that  this  condition  has  a  dangerous 
tendency  to  cause  fresh  recourse  to  drink  for  its  temporary 
relief,  and  that  there  can  be  no  doubt  that,  in  the  long- 
run,  the  constant  recurrence  of  slight  poisoning  tends  to 
set  up  organic  disease,  we  might  say  less  about  this 
result  of  alcohol. 

Amongst  the  labouring  classes,  and  in  certain  trades, 
especially  those  involving  long  hours  and  night-work,  as 
well  as  in  many  of  the  more  educated  classes,  spirits  are 
especially  taken ;  and  when  taken  undiluted  or  with  a 
little  water,  are  especially  liable  to  cause  these  symptoms. 
And  this  is  one  of  the  reasons  why  the  "  morning  nip  " 
before  breakfast,  or  before  work,  is  so  often  indulged  in 
and  is  so  dangerous ;  for  while  it  relieves  for  a  time  the 
tremor  and  the  discomfort,  it  only  aggravates  the  condi- 
tion which  produces  them. 

Tremhlmg. — Another   condition    which   we   have  just 


ALCOHOL  :  ITS  USE  AND  ABUSE.  45 

mentioned,  one  of  the  special  results  of  alcohol,  is  tremor^ 
shakiness  of  the  hands,  so  that  they  are  unsteady  when 
at  rest,  or  if  the  hand  is  held  out  it  is  seen  to  vibrate 
slightly ;  or  in  the  more  advanced  condition,  "  shakes 
like  an  aspen  leaf."  We  have  seen  this  in  a  spirit-drinkei 
as  almost  the  only  symptom ;  he  was  a  barber,  working 
early  and  late  in  shaving,  and  to  "  steady  his  hand  "  took 
constantly  raw  spirits,  at  first  to  relieve  fatigue,  then 
because  he  found  that  if  he  discontinued,  his  hand  was  too 
shaky  to  use  the  razor.  Complete  abstinence  from 
alcohol,  anci  strong  coffee,  quite  removed  his  tremors  and 
his  desire  for  spirits.  And  this  is  only  a  sample  of  a 
class,  though  few,  it"'-  may  be  feared,  have  so  much  self- 
control  as  to  relinquish  the  habit,  or  so  honest  a  purpose 
in  drinking.  This  tremor  has  its  highest  expression 
during  the  condition  of  mental  derangement  known  as 
delirium  tre?nens.  We  need  not  dwell  upon  the  other 
slight  effects  mentioned  above. 

II.  The  effects  of  large  repeated  doses  in  causing 
drunkenness  and,  later,  delirium  treinens. — It  would  be 
outside  our  purpose  to  speak  much  of  these.  We  have 
just  described  some  of  the  stages  of  intoxication,  and 
others  will  appear  from  the  description  of  the  physiological 
action  of  alcohol.  The  evils  of  drunkenness  are  so  obvious 
to  all  in  their  social,  moral,  and  physical  aspects,  and  so 
wide  a  field  of  discussion  would  be  opened,  that  we  may 


46  alcohol:  its  use  and  abuse. 

leave  this  for  others ;  we  have  already  said  that  it  is  a 
great  mistake  to  believe  that  those  who  never  become 
intoxicated  do  not  injure  themselves  and  others  by 
drinking. 

The  condition  known  as  delirium  tremens  may  be,  and 
perhaps  most  frequently  is,  produced  without  actual  drunk- 
enness in  the  common  use  of  the  word.  Those  who  drink 
hard  but  keep  from  actual  loss  of  consciousness,  especially 
those  engaged  in  hard  mental  work,  or  subjected  to  great 
moral  strain  or  shock ;  and,  too,  those  of  certain  tempera- 
ments, are  peculiarly  liable  to  it.  It  is  preceded  usually 
by  loss  of  sleep,  ideas  of  persecution  or  of  injury  with  no 
foundation  in  fact,  and  slight  hallucinations,  especially  at 
night,  the  man  the  while  in  the  day  looking  anxious, 
slightly  exeited,  nervous  and  tremulous,  and  perhaps  nar- 
rating, as  actual  occurrences,  the  hallucinations  of  the 
preceding  night.  Then  the  senses  are  partly  lost,  he  sees 
spectres,  horrible  and  foul  creatures  about  him,  has  all 
sorts  of  painful  terrifying  visions  (whence  the  common 
name  of  "  the  horrors "),  is  extremely  tremulous,  and 
either  excited  or  lies  prostrate,  trembling  violently  on 
movement,  sleepless,  anxious,  and  a  prey  to  spectres  and 
terrors  of  the  imagination.  But  we  need  follow  him  no 
further  to  recovery  or  death,  but  leave  the  study  of  his 
condition  to  the  doctor  and  the  moralist. 

Another  condition  often  and  wrongly  confounded  with 


alcohol:  its  use  and  abuse.  47 

this  is  that  known  as  dipsomania.  It  has  m  common 
with  it  the  fact  that  those  who  are  a  prey  to  it  do  get 
deUrium  tremens  by  their  drinking ;  but  it  is  a  name 
properly  appHed  only  to  a  disease,  usually  associated 
with  mental  disease  or  inherited  tendency,  in  which  there 
occurs,  periodically,  an  irresistible  craving  for  drink,  not 
always  limited  to  alcoholic  drinks ;  and  during  the  con- 
tinuance of  this  craving  everything  is  drunk  which  can  be 
got  hold  of.  The  attack  over,  whether  by  intoxication 
or  by  restraint,  the  patient  (for  such  he  should  be)  is  free 
for  a  time,  often  a  long  time,  from  any  tendency  to  drink. 
This  is,  and  should  be,  regarded  and  treated  as  a  mental 
disease,  and  has  no  resemblance  to  the  commoner  forms 
of  excess  in  drinking.  But  we  must  add  that  drinking 
itself  induces  a  strong  craving  for  alcohol,  so  that  some- 
times it  may  be  hard  to  say  whether  a  man  is  only 
suffering  from  his  bad  habits  or  from  a  mental  disease. 
The  chief  point  of  difference  is  that  in  the  true  dipso- 
maniac the  attacks  are  periodical,  and  there  is  often  a 
family  tendency  to  insanity  or  to  other  nervous  diseases. 

III.  The  diseases  which  result  from  the  continued 
excess  in  alcohol  are  very  numerous,  often  combined  in 
the  same  person,  and,  as  is  the  case  with  nearly  all 
diseases  of  one  part,  leading  to  further  changes  in  other 
parts. 

I.  We  may  speak  first  o(  gmcral  conditions,  affecting  all 
4 


48  ALCOHOL  :    ITS  USE    AND    ABUSE. 

parts  of  the  body.  And  here  we  cannot  even  attempt  to 
mention  all  those  slighter  general  states  which  are  so 
commonly  seen  in  those  who  drink.  The  moral  tone  is 
lowered,  there  is  often  a  coarseness  of  look  and  manner 
which  mark  the  general  deterioration ;  the  memory  is 
less  clear  and  retentive,  the  grasp  of  the  intellect  is 
enfeebled,  there  is  less  power  of  mental  work,  and  loss 
of  that  self-control  and  self-respect  which  gain  the  confi- 
dence of  others.  Often  there  is  a  peculiar  suspicion 
shown  in  the  look,  a  suspicion  of  being  suspected ;  or  a 
restless  wandering  look  which  betrays  to  the  careful 
observer  a  consciousness  of  deterioration.  Then  the 
face  assumes  a  slightly  puffy  look,  due  at  first  to  want 
of  "  tone  "  of  the  muscles  of  expression,  and  later  to 
actual  degeneration,  and  to  the  accumulation  of  fat  over 
them.  Or,  in  rarer  instances,  there  is  instead  a  pinched, 
wasted  look,  conjoined  with  a  similar  condition  of  the 
body. 

The  most  common  general  condition  is  that  which  is 
known  as  "  fatty  degeneration,"  which  consists  of  two 
quite  distinct  parts.  All  over  the  body,  beneath  the 
skin,  where  it  is  thicker  in  some  parts  than  others,  and 
also  in  all  the  chinks  and  spaces  around  and  between 
the  chief  organs  (except  the  brain  and  spinal  cord),  there 
•s  in  the  healthy  state  what  is  known  as  fatty  or  adipose 
tissue,  which  is  made  up  of  minute  cells  filled  with  oil, 


alcohol:  its  use  and  abuse.  49 

closely  packed  together.  In  addition  to  this,  some  organs, 
especially  the  liver,  contain  some  oil,  which  is  burnt 
as  fuel  when  needed,  as  we  see  in  hybernating  animals, 
who  are  said  to  store  up  a  large  quantity  before  the  winter. 
The  use  of  the  fat  or  oil  is  to  form,  as  it  were,  pads,  and 
to  lubricate  the  muscles,  to  keep  in  the  warmth,  and  to  be 
burnt  up  or  used  up  when  wanted.  One  common  effect  of 
alcohol  is  to  cause  an  increase  of  this  fat,  so  that  in  some 
cases  it  becomes  very  excessive,  especially  in  the  liver 
and  in  other  internal  parts  where  only  a  small  quantity 
ought  to  be  present. 

Another  change,  much  more  serious  and  important, 
but  which  goes  by  the  same  name,  is  a  change  of  other 
tissues  into  fat.  All  the  important  organs  of  the  body 
are  composed  of  various  forms  of  "  albuminoid  "  matter, 
and  are  of  "  protoplasmic "  nature ;  that  is,  they  are 
highly  complex  organic  bodies,  having  some  relation  to 
albumen,  and  endowed  with  living  powers,  which  vary 
with  the  different  tissues  they  constitute.  Thus  we  have 
muscle,  made  up  of  minute  filaments  which  have  the 
power  of  contracting ;  nerves,  formed  by  delicate  cords, 
which  convey  nerve-impulses  of  whatever  nature  *  cells, 
some  of  which  make  ferments,  &c.,  to  digest  food,  some 
prepare  it  for  use,  and  so  on,  but  all  go  to  make  up 
what  we  call  organs,  and  have  special  work  of  some  kind, 
and  a  peculiar  power  of  doing  it.     Now  when  one  of 


50  ALCOHOL  :    ITS   USE   AND   ABUSE. 

these  elements  dies  or  slowly  decays,  the  albuminous  or 
protoplasmic  substance  of  which  it  is  made  first  loses 
its  peculiar  vital  properties,  then  breaks  up  into  minute 
granules,  and  these  granules  are  further  altered  till  they 
become  oil  globules,  in  which  state  they  are  carried  off 
by  the  blood  to  be  burnt  up.  We  cannot  follow  all  the 
steps  of  the  process  chemically,  but  we  know  that  the 
protoplasm  loses  its  nitrogen,  oil  containing  none,  and 
when  the  stage  of  oil  drops  is  reached,  we  know  that 
the  part  of  the  organism  is  for  all  work  and  use 
dead. 

It  is  this  form  of  "  fatty  degeneration  "  which  alcohol 
especially  produces  and  which  makes  its  results  so  dan- 
gerous. We  see  it  most  in  the  heart  and  liver,  but  an 
analogous  process  occurs  in  the  blood-vessels,  in  the 
nerves,  and  indeed  in  all  vital  organs.  It  means  simply 
living  decay  of  parts  of  our  most  important  organs,  piece- 
meal death  going  on  in  the  live  body.  And  when  alcohol 
is  taken  in  large  repeated  doses  continuously,  this  change 
may  become  very  advanced  in  but  a  short  time.  Other 
poisons  produce  it  more  rapidly,  especially  phosphorus. 

There  is  another  general  deterioration,  which  is  of 
almost  equal  importance.  All  organs  contain  a  material 
which  forms  their  skeleton  or  framework,  holds  the  more 
special  vital  parts  together,  and  forms  coverings  for 
them.      This  is  called  "  connective "  or   fibrous  tissue, 


ALCOHOL:    ITS    USE    AND    ABUSE.  5 1 

Now  this,  when  in  proper  quantity  and  arrangement,  is 
essential,  but  when  it  grows  beyond  normal  limits  it  dis- 
places and  destroys  the  more  important  vital  elements, 
so  that  its  overgrowth  in  any  organ  causes  to  an  equal 
degree  undergrowth  or  destruction  of  those  more  im- 
portant parts.  Nor  is  this  all ;  for  this  tissue  grows  from 
cells  which  are  soft  and  elastic,  but  gradually  these  are 
joined  together  into  fibres,  and  these  into  thicker  fibres, 
and  as  they  grow  and  get  stronger  and  denser,  they  con- 
tract and  get  shorter,  so  that  they  crush  the  softer  and 
more  yielding  tissues  which  they  surround  and  divide. 
Now  a  scaffolding  or  framework  is  very  useful  in  proper 
limits ;  but  if  we  use  growing  trees  and  their  branches 
for  our  timbers  and  joists,  and  they  can,  and  do,  still  grow 
and  flourish,  our  house  will  not  be  likely  to  be  YQry  per- 
manent ;  nor  does  this  simile  give  more  than  a  very  feeble 
idea  of  what  happens  in  the  case  of  a  contracting  tissue 
in  an  organ. 

It  is  from  this  overgrowth  or  fibrous  change  that  many 
of  the  most  serious  internal  diseases  result ;  and  it  pro- 
duces especially  the  diseases  of  the  liver  and  kidneys 
which  are  so  fatal  to  chronic  drinkers. 

But  there  are  other  general  constitutional  conditions 
which  are  produced  by  over-indulgence  in  drinking,  even 
when  the  habit  is  never  carried  to  excess  of  visible  amount. 
It  is  far  more  difficult  to  classify  and  accurately  describe 


52  alcohol:  its  use  and  abuse. 

these  general  states  of  the  system.  They  probably  depend 
on  an  early  stage  of  functional  derangement,  caused  by 
the  organic  diseases  of  which  we  are  about  to  speak, 
before  they  have  reached  any  perceptible  degree.  A 
tendency  to  gout,  some  forms  of  rheumatism,  stone  and 
the  like,  are  now  very  commonly  believed  to  result  from 
habitual  slight  excess  in  alcohol.  Very  strong  opinions  to 
this  etfect  have  of  late  years  been  expressed  by  some 
eminent  surgeons  and  physicians  whose  large  experience 
in  these  particular  diseases  entitles  their  opinion  to 
respect.  But  we  must  not  forget  that  it  is  not  merely 
the  direct  effect  of  alcohol  itself  with  which  we  have  to 
do — over-indulgence  in  wine  or  beer  means,  commonly, 
excess  in  eating,  bad  habits  as  to  rest,  exercise,  and  air, 
and  many  other  evil  habits  which  combine  to  produce 
the  results  mentioned.  They  are,  however,  indirectly 
attributable  to  the  use  of  alcohol. 

2.  The  destruction  of  particular  organs  is  rather  in  the 
province  of  the  physician  than  suited  to  a  popular  essay. 
The  whole  system  may  be  involved,  or  only  certain  organs, 
especially  the  heart,  stomach,  liver,  kidneys,  and  brain  ; 
but  there  is  also  a  peculiar  tendency  to  some  chronic 
forms  of  lung-disease,  and  to  fatal  results  in  accidental 
diseases,  such  as  erysipelas,  inflammation  of  the  lungs, 
&c.  The  organ  affected,  and  the  form  of  disease,  depend 
in  part  upon  the  form  of  alcohol  and  its  degree  of  dilu 


ALCOHOL  :    ITS   USE   AND   ABUSE.  53 

tion,  upon  the  idiosyncracy  of  the  person,  and  upon  his 
general  temperament  and  habits. 

The  stomach  may  be  damaged  by  the  direct  action  of 
strong  alcohol,  by  repeated  derangement,  or  by  changes 
like  those  of  other  organs.  We  have  seen  that  one  of  the 
effects  of  alcohol,  especially  in  the  form  of  wine  or 
spirits,  is  at  first  to  stimulate  the  secretion  of  the 
stomach,  and  possibly  also  the  movements  on  which  the 
digestion  partly  depends.  We  found,  too,  that  the  local 
effect  is  to  dilate  the  blood-vessels.  This  over-action 
when  excessive  or  needless  is  followed  by  a  perturbed 
condition,  partly  due  to  an  exhaustion  from  the  over- 
action,  partly  to  the  direct  damaging  effect  of  the 
alcohol ;  and  the  derangement  of  the  liver  adds  also  to 
the  disturbance.  Now  when  this  irritation  is  repeated 
day  by  day,  week  by  week,  and  year  by  year,  we  need 
not  be  surprised  that  the  stomach  gets  altered  in  its 
structure,  even  if  the  temporary  derangement  is  only 
slight  at  any  given  time.  Gtifta  cavat  lapidem^  and  a 
"  drop  too  much  "  is  not  needed  to  wear  out  the  stomach. 
But  although  we  do  find  various  diseases  in  the  stomach, 
and  see  the  effects  of  deranged  digestion  as  a  result  of 
drinking,  there  is  a  marvellous  power  both  of  resistance 
and  recovery  on  the  part  of  the  stomach,  so  that  some 
long-standing  topers  maintain  their  digestion  and  have 
healthy  stomachs  to  the  last.    The  evil  is  bad  enough,  we 


54  ALCOHOL  :  ITS  USE  AND  ABUSE. 

need  not  exaggerate  it  by  the  absurd  and  impossible 
pictures  of  the  stomach  with  which  teetotal  lecturers 
delight  to  terrify  their  credulous  audiences. 

The  worst  form  of  stomach  disease  occurs  in  those  who 
take  spirits  on  an  empty  stomach,  and  particularly  in  the 
morning  with  "  bitters,"  "  absinthe,"  and  the  like,  which 
also  help  to  irritate  the  stomach  coats. 

The  liver  is  peculiarly  liable  to  disease,  for  all,  or  nearly 
all,  the  alcohol  taken  into  the  stomach  goes  into  the 
blood-vessels  wiiich  lead  to  the  liver,  and  all  the  blood 
from  the  stomach  circulates  through  the  minute  blood- 
vessels of  the  liver  before  it  goes  on  to  the  heart.  Hence 
the  evil  effects  of  which  we  have  spoken  are  usually 
most  strongly  marked  in  the  liver. 

The  changes  in  the  heart  are  especially  due  to  over- 
excitement  and  consequent  hypertrophy,  combined  with 
the  slow  deterioration  or  fatty  degeneration  of  its  muscle- 
fibres,  and  accumulation  of  fat  on  its  surface  also.  And 
other  more  complex  derangements  also  occur. 

The  kidneys  receive  from  the  blood  all  the  materials 
of  tissue  destruction  or  waste  which  are  not  burnt  off  the 
lungs  or  excreted  by  the  skhi,  as  well  as  the  greater  part 
of  excess  of  water  in  the  blood.  Alcohol  has  a  peculiar 
property  of  exciting  the  kidneys  to  over-action  by  tem- 
porary dilatation  of  the  blood-vessels,  which  produce  a 
condition  like   that   seen    on  the  skin  in   blushing.     It 


ALCOHOL  :    ITS    USE    AND    ABUSE.  55 

probably  also  acts  as  an  irritant  on  the  glandular  cells 
of  the  organ,  causing  them,  if  only  slightly  stimulated, 
to  excrete  more  organic  material  than  before.  Hence  the 
first  and  direct  action  is  irritation,  slight  and  transient, 
but  capable  of  repetition. 

But  a  part  of  the  action  is  more  complex,  and  is  pro- 
bably due  to  the  effects  upon  other  tissues  and  on  the 
blood.  We  have  said  that  the  kidneys  excrete  or  remove 
from  the  body  the  waste  products  of  tissue-combus- 
tion, and  waste,  and  many  other  bodies,  such  as  salts  of 
various  kinds  which  only  get  into  the  blood  by  accident 
or  design,  and  stay  only  a  short  time  in  the  body.  But 
before  the  waste  tissue  products  are  removed  by  the 
kidneys,  they  are  usually  in  great  part  converted  into 
the  form  of  a  salt  called  urea,  which  is  readily  soluble  in 
water.  It  is  now  believed  by  many  physiologists  that  the 
liver  plays  a  great  part  in  this  transformation ;  and  it  is 
also  at  least  known  that  retarded  oxidation  of  tissue  waste 
prevents  the  proper  reduction  into  urea.  Now,  by  what- 
ever mechanism,  whether  by  its  action  on  the  liver, 
or  on  the  blood,  or  by  its  power  of  retarding  oxidation, 
alcohol  does  prevent  in  some  degree  the  proper  changes 
in  the  tissue  waste,  so  that  a  larger  part  of  it  than  usual 
passes  out  in  the  form  of  uric  acid,  urates  and  other  sub- 
stances, which  are  less  soluble,  more  irritant,  and  defec- 
tively oxidized. 


56  ALi:OHOL  :    ITS    USE    AND    ABUSE. 

And  whether  from  this  cause,  or  from  repeated  conges- 
tion and  irritation,  alcohol  leads  at  last  to  widespread 
disease  of  the  kidneys  in  a  large  number  of  cases ;  in 
most  to  the  fibrous  form  of  degeneration ;  but  in  a  few 
more  rapidly  to  other  forms. 

We  have  already  pointed  out  that  the  nervous  system^ 
in  which  term  are  included  not  only  the  nervous  centres, 
such  as  the  brain  and  spinal  cord,  but  also  all  the  ganglia, 
nerve  fibres,  and  their  terminations,  undergo  various 
changes  as  the  result  of  drinking,  and  that  these  changes, 
whether  transient  or  permanent,  show  themselves  by 
altered  function  and  by  diminished  or  deranged  power. 
The  study  of  all  these  conditions  would  be  a  too  technical 
and  too  prolonged  one  for  its  introduction  here,  we  must 
therefore  leave  it,  mentioning  only  some  of  the  more 
obvious  results. 

The  very  important  question  of  the  effect  of  drinking 
in  causing  the  loss  of  mental  power  must  detain  us  a 
moment.  Many  would  ascribe  moral  deterioration  also 
to  an  organic  change  in  the  brain,  but  we  cannot  fully 
agree  with  this  view.  Moral  character  is  very  largely  in- 
fluenced by  habit,  by  the  acquired  control  of  the  highest 
cerebral  centres  over  the  lower ;  and  hence  the  continual 
paralysis  of  that  control,  and  the  constant  abolition  of  all 
power  of  self-restraint  must,  of  course,  aid  largely  in 
moral  deterioration.     But  we  cannot  go  further  than  this, 


ALCOHOL  :    ITS   USE    AND    ABUSE.  57 

the  habitual  drunkard  is  morally  defective  from  the  outset, 
and  his  habits  give  full  play  to  the  action  of  all  the  baser 
tendencies  of  his  nature.  Drunkenness  is  more  a  vice 
than  a  disease. 

But  does  the  constant  use  of  alcohol  in  moderate  or 
not  greatly  excessive  quantity  cause  moral  deterioration  ? 
No  more  important  question  could  be  proposed  than  this, 
nor  easily  one  more  difhcult  of  answer.  We  believe  the 
true  reply  to  be  that  whatever  quantity  causes  any  tempo- 
rary loss  of  moral  control  does,  if  repeated,  lead  to  moral 
deterioration,  but  that  short  of  this  no  such  result  is  pro- 
duced. But  we  must  say  that  of  those  who  habitually 
use  alcohol,  even  in  what  is  regarded  as  moderation,  a 
very  large  number  do  from  time  to  time  exceed  the  limit 
of  safety,  and  weaken  moral  control. 

The  effect  of  the  use  of  alcohol  on  the  mental  powers, 
observation,  memory,  and  judgment,  &c.,  is  exceedingly 
variable.  There  are  some  whose  nervous  system  is  espe- 
cially prone  to  be  affected  by  alcohol ;  others  who  resist 
its  action,  even  in  large  doses,  for  a  very  long  time.  The 
results  of  habitual  excess  are  seen  in  many  cases  in  a  de- 
cline of  intellectual  power,  loss  of  memory,  &c.,  but  this 
chiefly  when  there  is  great  excess  with  defective  power  of 
resistance.  We  are  speaking  now  only  of  the  permanent 
effects.  No  one  can  doubt  the  constant  effect  so  long  as 
alcohol  is  being  taken  in  excess.    And  we  have  no  doubt 


58         ALCOHOL  :  ITS  USE  AND  ABUSE. 

that  a  large  part  of  the  mental  deterioration  which  we  see  in 
chronic  drinkers  is  simply  the  resultant  of  long-continued 
want  of  exercise  of  the  mental  powers,  which  for  their 
proper  action  require  continued  exercise  and  habit.  Be- 
yond this,  there  is  actual  decay  of  nerve  tissue,  partly  from 
disuse,  partly  the  consequent  of  changes  of  nutritive 
action  and  of  vascular  supply. 

We  are  here  again  met  with  the  inquiry  whether  the 
habitual  use  of  alcohol  in  anything  short  of  excess  causes 
diminution  of  mental  power.  And  we  must  again  reply 
that  we  know  of  no  evidence  that  any  such  diminution  is 
produced,  so  long  as  there  is  no  ejccess,  in  the  proper 
meaning  of  the  term,  but  that  there  is  great  chance  of 
reduction  of  mental  power  with  far  less  than  is  commonly 
regarded  as  excess.  And  even  when  there  is  no  per- 
manent injury,  however  slight,  the  amount  of  mental  work 
which  can  be  done  without  the  effect  is  certainly  dimin- 
ished  by  very  slight  excess.  On  the  other  hand,  we  shall 
*  show  that  a  moderate  use  of  alcohol  is  in  many  cases  a 
safeguard  against  the  over-exertion  of  the  mind  to  the 
injury  of  the  brain. 

Of  other  permanent  nerve  disorders  caused  by  alcohol 
we  need  say  htde  here.  The  various  forms  of  paralysis, 
convulsions,  and  mental  derangement  as  the  result  of 
great  excess,  form  a  very  important  study  for  the  phy- 
sician, but  never  result  from  any  slight  degree  of  drinking, 


ALCOHOL  :    ITS   USE   AND   ABUSEw  59 

find  are  beyond  our  province  here.  The  researches  of  late 
years  have  shown  that  excess  in  alcohol  can  and  does  pro- 
duce nervous  disorders  which  very  closely  resemble  those 
due  to  organic  disease  j  the  important  practical  point  for 
those  who  are  not  doctors  is  never  to  supply  stimulants 
to  persons  with  paralysis  and  the  like  without  the  doctors 
orders.  We  have  known  two  patients  killed  in  this  way, 
by  secretly  supplying  them  with  spirits  ;  they  were  suffer- 
ing from  paralysis  actually  caused  by  alcohol,  and  their 
friends  thought  they  had  serious  disease,  and  wanted 
*'  keeping  up,"  to  which  they  had  been  used ;  the  doctor's 
orders  of  strict  abstinence  were  regarded  as  his  "  fad," 
and  the  patients  were  "  kept  up "  into  fatal  delirium 
tremens. 

We  see,  then,  that  intemperance  is  a  most  fruitful  cause 
of  disease  ;  and  this  is  true  not  only  of  the  individual,  but  of 
the  population  taken  as  a  whole.  For  not  more  surely 
does  decay  and  degeneration  of  the  body  of  the  individual 
occur,  as  the  result  of  excessive  drinking,  than  an  injury 
to  the  body  corporate ;  for  the  disease  is  propagated 
in  the  offspring,  and  tells  upon  the  com-munity.  The 
children  of  parents  addicted  to  drink,  even  if  not  decrepit 
and  deformed,  have  the  tendency  to  degeneration  in  some 
one  or  other  way  implanted  in  their  constitution,  and 
like  a  birth-mark,  or  a  mole,  or  the  colour  of  hair  and 
eyes,  it  may  be  handed  down  to  posterity.      There  is 


5o  ALCOHOL  :  ITS  USE  AND  ABUSE. 

no  more  wonderful  problem  in  nature  than  this  handing 
down  of  tendencies,  and  even  instincts  and  emotions, 
from  parents  to  children.  Account  for  it  as  we  may,  we 
must  accept  the  fact  that  acquired  tendencies  to  disease 
are  so  propagated,  and  that  especially  the  children  of 
parents  whose  brains  are  injured  by  alcohol  are  more 
prone  than  others  to  mental  disease,  and  to  those  widely 
varied  diseases  which  we  call  "  nervous."  We  might 
enlarge  much  upon  this  branch  of  our  subject,  and  trace 
out  the  effects  of  physical,  mental,  and  moral  deteriora- 
tion of  parents  upon  their  offspring ;  but  this  has  already 
been  frequently  done  by  others.  There  is  good  reason 
to  believe  that  a  propensity  to  drinking  is  often  hereditary, 
that  propensity  having  been  in  the  first  instance  acquired. 
But  it  must  be  remembered  that  we  speak  here  of  the 
results  of  excess,  and  not  of  moderation  and  temperance. 
In  concluding  this  part  of  our  subject  we  must  say  a 
word  or  two  upon  the  treatment  of  excess  in  alcohol. 
The  value  of  restraint  and  seclusion,  and  the  ways  in 
which  they  should  be  enforced,  we  cannot  here  discuss. 
But  many  men  who  desire  to  give  up  drinking  find  it 
hard  to  do  so.  One  great  necessity  is  the  substitution 
of  something  to  replace  the  alcohol.  Bitter  aromatic 
tonics  best  serve  this  purpose,  and  may  be  taken  at  the 
limes  when  spirits  and  water  would  otherwise  be  drunk. 
Those  wlio  have  acquired  the  habit  of  taking  wine  or 


ALCOHOL  :    ITS    USE    AND    ABUSE.  6 1 

spirits  at  night  or  in  the  morning,  will  often  find  that  a 
glass  of  milk  will  serve  their  purpose  better.  In  all 
confirmed  cases  total  abstinence  and  medical  treatment 
are  advisable. 


CHAPTER  IV. 

THE   USES    ar   ALCOHOL   AND    ALCOHOLIC    BEVERAGES. 

Alcoholic  drinks  have  their  uses  in  health  and  in 
disease :  we  may  consider  the  former  first.  It  may  be 
laid  down  as  an  axiom  that  a  man  of  good  constitution 
and  in  good  health,  with  healthy  surroundings  of  food, 
air,  and  exercise,  requires  no  alcohol.  But  so  numerous 
are  the  departures  from  the  typical  standard  of  health 
and  of  good  health  conditions  that  a  need  of  alcohol 
sometimes  arises. 

Age  exerts  an  important  influence.  Children  under 
lo  years  of  age  ought  never  to  take  alcohol  unless  during 
illness  or  under  medical  advice ;  and  in  the  large  majority 
of  cases,  more  harm  than  good  is  done  by  taking  wine 
or  beer  between  the  ages  of  14  and  25,  especially  at  the 
period  of  adolescence.*     But  between  the  age  of  9  or  10, 

*  "Plato  forbids  children  wine  till  eighteen  years  of  age,  and 
being  drunk  till  forty." — Montaigne. 


62  ALCOHOL  :  ITS  USE  AND  ABUSE. 

and  14  or  15,  there  is  often  a  rapid  growth  and  a  great 
strain  both  on  the  mental  and  physical  capacities,  and  if 
this  cannot  be  met  by  abundant  rest,  exercise,  air,  and 
food,  there  is  often  good  from  a  moderate  allowance  of 
alcohol.  But  in  this,  as  in  other  matters  of  the  kind, 
there  is  great  variety  in  the  age  at  which  it  is  needed, 
and  the  amount  required.  From  25  to  35  or  40,  if  there 
is  good  health,  alcohol  is  certainly  not  needed,  provided 
always  that  the  surroundings  be  healthy.  And  it  is 
especially  between  20  and  30  that  the  use  of  alcohol 
habitually  in  any  excess  has  the  most  deleterious  influ- 
ence both  upon  body  and  mind.  After  35  or  40  the  uses 
of  alcohol,  in  moderation,  are  most  perceptible,  and  from 
40  to  60  it  is  most  needed.  Later,  many  who  have  been 
in  the  habit  of  using  wine  or  spirits,  find  it  necessary  to 
restrict  the  quantity,  and  to  take  it  in  a  different  form. 

But  after  all,  such  rules  as  these  are  subject  to  great 
modification  in  individual  cases,  and  hence  are  of  little 
value  in  practice ;  and  it  wdll  be  well  to  inquire  what 
alcohol  can  do  to  promote  health,  and  in  what  ways  it 
may  be  usefully  employed. 

Alcohol  has  been  supposed  to  aid  digestion,  and  itself 
also  to  act  as  a  food ;  to  promote  nutrition ;  to  be  a 
stimulant  and  a  sedative,  and  to  give  warmth  to  the  body. 
We  may  inquire  how  far  it  really  possesses  these  quahties, 
and  to  what  degree  they  may  be  utilised  :  they  are  so 


ALCOHOL  :   ITS   USE  AND  ABUSE.  63 

much  involved  in  each  other  that  we  cannot  absolutely 
separate  tliem.  . 

On  Digestion. — Whether  alcohol  is  a  food  or  nq^it  un- 
questionably aids  in  the  digestion  and  assimilation  of 
food  in  some  cases,  where  without  it  food  is  not  properly 
digested.  We  will  not  now  discuss  the  various  theories 
of  its  action.  It  may  be,  by  its  action  directly  on  the 
stomach,  promoting  the  flow  of  blood ;  by  permitting  of 
that  rest  of  nervous  energy  which  is  one  of  the  main  aids 
to  healthy  digestion;  by  increasing  secretion,  or  what 
not — all  of  which  might  be  amply  discussed  in  a  work  on 
medicine ;  but  the  fact  remains  that,  in  a  large  number 
of  cases,  a  moderate  allowance  of  alcohol  taken  with  food 
does  aid  digestion  and  thus  promote  nutrition.  Even  in 
infancy,  in  some  states  of  wasting,  alcohol  is  of  great 
value.  Wine  is  the  form  in  which  the  alcohol  is  most 
often  useful  for  this  purpose.  In  rapidly  growing  and 
unhealthy  children,  who  take  their  food  badly,  and  are 
not  nourished  by  it — indeed  in  many  conditions  of  con- 
tinued ill-health  in  childhood  and  early  youth — a  small 
daily  allowance  of  wine,  port  or  sherry,  diluted  with  water 
and  taken  at  meals,  is  extremely  beneficial. 

In  early  manhood  and  womanhood,  if  the  habits  are 
properly  regulated,  there  is  more  rarely  the  actual  necessity 
for  stimulants  to  aid  digestion.  More  often  their  dis- 
continuance would  restore  it.  Young  women,  especially 
5 


64  alcohol:  its  use  and  abuse. 

of  sedentary  habits  and  keeping  late  hours,  or  neglect- 
ing to  take  exercise,  with  no  special  duties  requiring 
thought  and  energy,  very  often  suffer  from  capricious 
appetite,  some  symptoms  of  indigestion,  languor,  and 
debility,  for  which  they  are  often  advised  to  take,  or  do 
take,  wine,  both  at  and  between  meals,  and  in  the  multi- 
tude of  instances  only  keep  up  and  aggravate  the  very 
symptoms  of  which  they  complain.  And  we  might  say 
the  same  of  many  others — especially  young  men  who 
take  wine  or  beer  in  the  morning  or  at  mid-day,  or  who 
fast  all  day,  and  are  exhausted  and  void  of  appetite  at 
dinner-time.  Alcohol  is  not  here  the  remedy ;  light  food 
at  mid-day,  with  chocolate  or  milk,  and,  if  need  be,  a  cup 
of  tea  or  coffee  an  hour  before  dinner,  are  far  better 
treatment.  In  a  great  number  of  cases,  proper  food  taken 
at  proper  times  would  make  the  use  of  alcohol  for  this 
purpose  unnecessary. 

A  very  large  number  of  middle-aged  and  elderly  people 
do,  however,  find  that  some  wine  or  beer  at  dinner  aids 
them  in  digestion.  We  might  provide  them  with  a 
number  of  theories  as  to  the  way  in  which  this  occurs ; 
we  prefer  to  point  out  the  fact,  and  to  caution  them 
against  converting  a  right  use  into  a  misuse.  Nor  must 
the  effect  of  habit  in  creating  necessities  be  forgotten. 

We  may  here  say  a  word  for  one  mode  of  action  of 
alcohol  which  is  too  often  left  out  of  sight  by  strictly 


ALCOHOL  :   ITS   USE   AND   ABUSE.  65 

scientific  people.  Emotions,  such  as  pleasure,  happiness, 
discontent,  and  the  like,  are  too  evanescent  and  im- 
ponderable quantities  to  gain  the  notice  of  the  physi- 
ologist and  chemist.  It  is  true  that  the  modern  vitalist 
looks  upon  them  as  an  indication  of  the  state  of  the 
brain-cells  which  may  be  of  interest  and  value,  but  the 
truly  scientific  man  is  too  much  engrossed  with  physical 
properties  to  care  for  the  existence  of  such  mere  feehngs 
in  other  people.  He  can  see  that  alcohol  causes  the 
blood-vessels  to  dilate,  the  gastric  follicles  to  secrete; 
that  in  excess  it  flushes  the  face,  makes  the  gait  un- 
steady, and  so  on,  and  condemn  this  action  as  needless 
and  wasteful.  But  the  effect  even  of  slight  and  almost 
unconscious  states  of  feeHng  upon  all  these  processes 
seem  to  escape  his  notice.  The  sight  of  green  trees, 
the  sound  of  the  sea,  the  smell  of  flowers,  may  give 
energy  and  appetite  to  the  invalid  in  such  a  way  as  to  be 
perceptible.  The  healthy  man  may  be  less  conscious  of 
such  emotion,  but  it  may  strongly  influence  him.  Appe- 
tite and  digestion,  and  many  other  functions,  are  very 
greatly  under  the  control  of  feeling.  Some  cannot  eat 
heartily  in  company,  nor  others  alone ;  a  smell,  a  slight 
taste,  will  destroy  the  appetite  and  digestion.  Perhaps 
more  than  anything  else,  great  mental  preoccupation, 
such  as  business  cares  and  worries,  may  completely  check 
digestion.     Now  alcohol  in  some  of  the  liquors  which 


66  alcohol:  its  use  and  abuse. 

contain  but  a  very  small  quantity,  such  as  light  ales  or 
wines  (we  would  especially  mention  light  dry  effervescing 
wines),  and  even  a  small  amount  of  these,  do  check  in 
many  cases  the  current  of  these  thoughts  and  cares  for 
a  time,  and  the  slight  degree  of  pleasure  thus  excited 
serves  to  set  the  digestive  process  in  action.  This  is  not 
only  a  lawful  use  of  alcohol,  it  is  one  which  is  in  many 
cases  very  beneficial,  and  to  neglect  it  would  be  wrong. 
Because  ninety-nine  persons  out  of  a  hundred  misuse  it, 
it  none  the  less  remains  true  that  it  has  a  right  use.  Let 
no  one,  however,  mistake  our  meaning.  Strong  wine  is 
not  nearly  so  well  calculated  to  produce  this  effect  as 
light  wine  diluted  with  water,  and  where  a  light  heart 
and  cheerful  company  make  this  needless,  it  is  an  abuse 
of  alcohol  to  take  it. 

To  speak  of  the  danger  of  producing  such  slight  ex- 
citement of  the  heart's  action  as  this,  to  regard  it  as 
shortening  the  life  and  producing  physical  and  mental 
decay,  is  an  abuse  of  science;  if  it  were  true,  every 
exertion,  every  pleasing  emotion,  nay,  all  activity  of 
every  sort,  would  tend  to  shorten  our  days,  and  they 
alone  would  be  wise  and  happy  who  existed  in  torpor, 
with  only  such  food  as  they  could  get  with  the  least 
possible  exertion,  and  that  only  sufficient  to  keep  body 
and  soul  together.  Science  will  never  gain  a  proper 
influence  over  the  actions  of  intelligent  men  so  long  as 


ALCOHOL  :  ITS  USE  AND  ABUSE.  6^ 

her  assertions  are  contrary  to  the  common-sense  and 
inteUigence  of  rational  beings. 

Alcohol  as  a  Food. — The  question  whether  alcohol  is  a 
food  is  one  which  has  been  obscured  by  numerous  mis- 
statements and  fallacies.  It  has  been  discussed  on 
chemical  and  physiological  grounds,  and  by  the  light 
of  experience.  Chemically,  it  is  a  fact  that  alcohol 
contains  no  nitrogen  ;  the  body  requires  nitrogen  for  its 
nutrition,  hence  it  is  stated  that  alcohol  cannot  support 
life  alone.  But  this  is  also  true  of  starch  and  oil,  two 
of  our  chief  food  ingredients.  If  alcohol  is  burnt  up 
in  the  body  it  does  act  to  some  extent  as  a  food. 
Some  physiologists  have  stated  that  all  the  alcohol 
taken  passes  out  of  the  body  again  unchanged.  This,  if 
true,  would  show  that  it  is  not  a  food ;  but  further  ex- 
periments have  shown  that  only  a  very  small  quantity  of 
the  alcohol  does  pass  out  unaltered,  the  greater  part  is 
burnt  up  in  the  body.  Certain  observations  on  persons 
in  old  age  or  disease  show  that  Hfe  can  be  supported  for 
a  long  time  on  a  diet  which  contains  little  but  pure 
spirits  and  water ;  in  these  exceptional  cases  the  alcohol 
evidently  acting  as  a  food. 

But  all  these  results  of  experiment  and  observation 
only  refer  to  very  exceptional  conditions,  and  are  not  of 
much  value  for  our  purpose.  For  no  one  would  think 
of  taking,  as  a  food,  in  health,  an  amount  of  alcohol 


68  ALCOHOL  :  ITS  USE  AND  ABUSE. 

sufficient  to  be  an  important  ingredient  in  his  diet.  Four 
glasses  of  sherry  would  supply  at  the  outside  only  an 
infinitesimal  part  of  the  carbon  daily  needed  by  a  healthy 
man,  that  is  to  say,  from  the  alcohol  itself.  It  is  scarcely 
necessary,  then,  to  consider  this  question ;  it  is  one  of 
little  practical  moment. 

The  more  important  question  is,  if  an  allowance  of 
alcohol  is  taken  with  food  of  ordinary  kinds,  is  more 
work  done  in  the  system  than  if  no  alcohol  is  taken. 
Many  experiments  have  been  made  to  decide  this.  Like 
all  such  experiments  they  are  very  difficult  to  conduct 
accurately;  and  the  quantity  of  alcohol  given  has  ex- 
ceeded that  which  could  be  called  moderate.  According 
to  the  late  Dr.  Parkes,  one  of  the  greatest  authorities  on 
the  subject,  the  effect  on  bodily  labour  is  that  a  small 
quantity  of  alcohol  does  not  produce  much  effect,  but 
that  more  than  two  fluid  ounces  daily  manifestly  lessens 
the  power  of  sustained  and  strong  muscular  work.  Even 
when  the  quantity  is  not  excessive  it  seems  doubtful 
whether  alcohol  is  beneficial,  for  it  increases  the  action 
of  the  heart  beyond  the  necessary  degree  ;  hence  it 
should  only  be  used  when  an  excessive  effort  is  to  be 
made,  which  must  be  made  without  giving  the  heart 
proper  time  for  rest 

The  effect  on  mental  work  is  more  doubtful.  When 
mind  and  body  are  exhausted  by  over-work  and   want 


ALCOHOL  :    ITS    USE   AND   ABUSE.  69 

of  food,  alcohol  no  doubt  restores  the  power  of  free 
thought,  and  removes  mental  preoccupation.  This  it 
does  in  the  way  which  we  have  already  described,  by 
quickening  the  circulation  in  the  brain,  and  by  its  slight 
narcotic  and  deliriant  properties.  When  taken  with 
food  it  is  not  easy  to  decide  how  much  of  the  effect  is 
due  to  the  food  alone.  But  whilst  there  is  no  doubt  that 
in  many  conditions  alcohol  does  for  a  time  promote  the 
flow  of  thought  and  idea,  it  diminishes  the  power  of  clear 
and  consecutive  reasoning,  and  its  use  is  nearly  always 
followed  by  greater  exhaustion  and  less  power  of  appli- 
cation. One  may  perhaps  make  an  exception  in  the 
case  of  public  speaking  for  some  length  of  time,  where 
there  is,  in  addition  to  thought,  a  physical  strain  and 
some  excitement ;  alcohol  does,  in  some  cases  of  this 
kind,  enable  great  mental  efforts  to  be  performed. 

The  conclusion  is,  then,  that  in  ordinary  life,  only  so 
much  alcohol  as  is  of  use  to  insure  mental  rest  and  good 
digestion  should  be  taken.  Where  these  are  suflficient 
without  alcohol,  none  should  be  taken. 

Under  exceptional  circumstances,  such  as  exposure  to 
cold  or  heat,  or  extraordinary  exertion,  is  alcohol  bene- 
ficial? Perhaps  the  best  possible  test  is  afforded  by 
experience  in  the  army.  It  is  the  almost  unanimous 
experience  of  those  who  have  given  special  attention  to 
the  question,  that  so  far  from  being  an  aid  to  great  exer- 


;o         ALCOHOL  :  ITS  USE  AND  ABUSE. 

tion,  and  to  the  resistance  of  extremes  of  temperature, 
alcohol  acts  injuriously;  and  that  such  conditions  are 
far  better  supported  without  it.* 

The  behef  that  alcohol  produces  warmth,  and  is  there- 
fore to  be  used  on  all  occasions  when  there  is  a  liability 
to  chill,  is  one  of  the  most  common  of  popular  errors,  or, 
at  least,  is  so  regarded  by  scientific  men.  For  experi- 
ments have  shown  that  the  principal  action  of  alcohol  is 
to  lower  the  temperature  of  the  body,  in  proportion  to 
the  quantity  taken.  It  is  a  well-known  fact  that  the  human 
body  (hke  that  of  all  animals)  has  a  certain  temperature, 
which  it  maintains,  with  very  slight  variations,  under  the 
varied  conditions  of  external  temperature.  Thus  it  has 
been  shown  that  in  the  tropics  and  in  the  extremest  cold 
there  is  a  scarcely  perceptible  difference  in  the  heat  of 
the  body,  so  long  as  health  is  maintained.    This  tempera- 

*  For  further  details  on  this  interesting  subject,  which  space 
forbids  us  from  entering  into,  see  the  following : — Parkes  on 
*  Hygiene,'  fourth  edition,  p.  281  ;  'Medical  Sketches  of  the  Expe- 
dition to  Egypt,'  by  Sir  James  M'Gregor,  p,  86;  Hamilton's 
'Military  Surgery,'  p.  61  :  Sir  John  Hall,  *  Medical  History  of  the 
War  in  the  Crimea,'  vol.  i.  p.  504;  'Journal  of  the  United  Service 
Institution,'  1871,  vol.  xv.  p.  74;  Captain  Huyshe's  'Account  of 
the  Red  River  Expedition ';  'Blackwood's  Magazine,'  Jan.  1871, 
p.  64  ;  *  The  Soldier's  Pocket  Book,'  by  Sir  Garnet  Wolseley, 
second  edition,  1871,  p.  172;  Dr.  W.  B.  Carpenter  on  'The 
Physiology  of  Temperance  and  Total  Abstinence,'  1870. 


ALCOHOL  :   ITS   USE   AND   ABUSE.  7 1 

turc  is  about  98^°  Fahrenheit ;  slightly  lower  in  hot  than 
in  cold  climates,  owing  to  greater  cooling  by  evaporation. 
This  uniform  heat  of  the  body  is  essential  for  the  healthy 
maintenance  of  nutrition,  and  appears  to  be  regulated  by 
the  nervous  system ;  that  is,  the  various  processes  which 
go  on  in  the  body  to  produce  heat,  or  to  get  rid  of  it,  are 
under  nervous  control.  A  large  number  of  diseases  cause 
this  regular  heat  to  be  deranged,  and  the  body  becomes 
too  hot  or  too  cool ;  and  alcohol,  like  several  other  drugs, 
has  the  power  of  lowering  the  temperature,  as  will  also 
the  external  application  of  cold  to  such  an  extent  as  to 
overcome  the  power  of  heat  production  in  the  body. 

Alcohol,  in  a  dose  of  any  amount,  has  also  the  power 
of  lowering  considerably  the  general  heat  of  the  body 
below  the  natural  standard,  and  in  drunken  persons  very 
low  temperatures  indeed  have  been  found.  We  do  not 
yet  know  exactly  how  this  effect  is  produced ;  some  think 
it  is  by  an  action  upon  the  central  controlling  part  of  the 
nervous  system,  just  as  we  may  derange  the  regulated 
filling  of  a  cistern  by  holding  up  the  ball-cock,  or  the 
rate  of  a  steam-engine  by  checking  the  governor-balls. 
Others  believe  that  it  acts  as  a  damper,  preventing  the 
proper  burning  of  the  substance  which  is  found  in  the 
liver,  and  produces  heat  by  combustion  in  the  lungs. 
Whichever  is  the  true  view,  there  is  no  doubt  about  the 
action.     But  this  is  not  quite  the  whole  truth,  for  careful 


72  ALCOHOL  :    ITS   USE   AND    ABUSE. 

observation  has  shown  that  quite  at  first,  when  only  a 
moderate  dose  of  alcohol  is  taken,  there  is  a  slight  rise  in 
the  body-temperature  to  the  amount  of  i*^  to  ij°  Fahr., 
which  lasts  for  a  short  time. 

We  must  understand,  however,  that  the  temperature 
of  all  parts  of  the  body  is  not  the  same,  for  different 
parts  are  more  exposed  to  external  cooling  agencies. 
The  skin  of  the  arms  and  legs  is  always  colder,  usually 
many  degrees  colder,  than  the  blood,  and  the  parts 
immediately  beneath  the  skin  are  cooler  than  the  deeper 
parts.  In  fact,  the  temperature  of  any  given  part  will 
depend  on  the  free  circulation  of  the  warm  blood  from 
the  interior  of  the  body,  and  the  absence  of  external 
cooling  agencies.  We  can  freeze  the  foot  or  hand  by  a 
freezing  mixture,  or  warm  it  by  exercise  or  rubbing,  which 
make  the  circulation  more  active  in  it.  In  fact,  we  may 
regard  it  as  one  of  the  very  important  functions  of  the 
blood  to  act  like  a  system  of  hot-water  pipes,  and  keep 
all  parts  of  our  bodily  house  warm.  The  longer  the  warm 
blood  stays  at  the  parts  most  exposed  the  m.ore  is  it 
cooled  ;  the  faster  it  is  changed  for  fresh  v/arm  blood  the 
better  it  keeps  up  its  heat. 

Now  this  is  what  alcohol  really  does  in  the  body,  and 
in  many  cases  what  we  want  it  especially  for.  It  widens 
the  channels  through  which  the  blood  flows,  and  thus 
lets  the  blood  course  more  freely  through  them,  and  it 


alcohol:  its  use  and  abuse.  73 

quickens  the  beat  of  the  heart,  and  sends  more  blood 
through  in  a  given  time.  Moreover,  cold  of  itself  con- 
tracts the  vessels,  and  makes  them  resist  the  passage  of 
the  blood ;  so  that  we  see  that  alcohol  directly  counteracts 
the  local  effects  of  cold. 

Now,  what  is  the  effect  of  a  chill,  such  as  from  riding  in  the 
cold,  getting  wet  feet,  &c.?  The  danger  seems  to  he  in  this, 
that  the  blood-vessels  of  some  part  of  the  body,  especially 
of  some  internal  organ,  owing  to  the  impression  made  by 
the  cold  upon  the  surface,  become  affected,  and  thus  a 
congestion  and  inflammation  is  set  up.  (The  complete 
explanation  is  too  technical  to  introduce  here.)  Now, 
although  the  effect  of  alcohol  in  any  large  quantity  may 
be  injurious,  it  is  quite  possible  and  probable  that  in  a 
moderate  one  it  may  for  a  time  do  good,  for  it  not  only 
acts  upon  the  vessels  of  the  part  chilled,  but  upon  those 
of  the  internal  organs,  and  thus  makes  the  circulation 
everywhere  more  rapid  and  easy.  For  the  evil  effect  of 
a  chill  is  not  in  the  lowering  of  the  general  temperature 
so  much  as  in  the  local  result,  and  its  secondary  effects 
on  other  parts. 

When,  however,  we  have  to  do  with  exposure  to  a  cold 
climate  or  a  very  hot  one,  the  question  is  very  different. 
The  habitual  use  of  alcohol  lowers  the  power  of  resistance 
to  cold  or  heat,  that  is,  it  interferes  with  the  central  con« 
trolling  authority,  and  so  works  mischief. 


74         ALCOHOL  :  ITS  USE  AND  ABUSE. 

Old  people  who  suffer  from  a  languid  circulation,  cold 
feet  and  hands,  and  the  like,  are  often  benefited  by 
alcohol,  for  example,  spirits  and  water  at  night ;  because 
the  blood-vessels  have  become  degenerated  and  rigid,  the 
heart  weakened  and  unable  to  overcome  the  resistance  in 
the  vessels.  Alcohol  both  aids  in  dilating  the  small 
vessels  and  quickening  and  invigorating  the  heart's  action, 
and  thus  equalises  the  circulation,  and  allows  the  warm 
blood  to  flow  freely  in  all  parts  of  the  body,  so  that  the 
warmth  of  the  more  distant  parts  is  maintained. 

We  may,  then,  use  alcohol  for  this  purpose  of  equalising 
heat  and  circulation  in  some  cases,  both  for  a  time  under 
exceptional  circumstances,  and  habitually  in  moderate 
doses,  where,  either  from  defective  action  of  the  heart  or 
a  degenerated  condition  of  the  vessels,  we  cannot  keep  up 
the  due  balance  of  action.  But  we  must  remember  that 
there  are  dangers  attending  the  use  of  alcohol  which 
should  make  us  always  prefer  other  means  for  attaining 
these  ends,  and  that  the  dose  must  be  strictly  regulated 
by  the  necessity  of  the  case.  It  is  better  that  a  man 
should  suffer  from  cold  feet  than  that  by  putting  alcohol 
into  him  we  should  make  the  heart  act  so  forcibly  as  to 
burst  a  vessel  in  his  brain  ;  and  better  that  he  should 
have  a  rather  languid  circulation,  than  that  he  should  set 
up  disease  of  his  vessels  and  organs  by  constant  use  of 
alcohol.     We  may  work  a  new  and  sound  boiler  at  high 


alcohol:  its  use  and  abuse.  75 

pressure,  but  we  must  be  careful  how  we  increase  the 
pressure  when  the  boiler  is  rusty  and  the  pipes  furred. 
In  many  such  cases  of  languid  circulation,  rest  in  a  re- 
cumbent posture  does  all  the  good  which  alcohol  could 
do,  without  its  attendant  dangers.  Sufficiently  frequent 
feeding  and  proper  clothing  must  also  be  attended  to. 

Alcohol  as  a  Stimulant. — Before  we  ask  whether  alcohol 
is  a  stimulant,  we  ought  to  inquire  what  we  mean  by  the 
word.  A  stimulus  is  something  which  acts  as  a  spur  or 
whip,  and  rouses  up  some  flagging  energy.  Does  alcohol 
do  this  ?  Many  people  have  said  that  it  does  not — that 
it  only  paralyses  the  higher  controlling  centres  and  lets 
the  lower  act.  But  whatever  theory  we  may  adopt,  no 
one  can  doubt  that  somehow,  under  some  conditions,  a 
glass  of  wine  does  revive  the  energies,  that  it  quickens 
the  heart's  action  and  the  sluggish  circulation,  at  any  rate 
for  a  time. 

No  doubt,  in  many  cases,  even,  perhaps,  in  most,  this 
over-action  is  followed  by  corresponding  depression ; 
there  is  drowsiness,  confusion  of  thought,  languor,  sluggish 
alimentary  action,  especially  if  the  stimulation  is  at  all 
more  than  absolutely  necessary.  So  that  some  say  that, 
on  the  whole,  the  stimulant  effect  adds  nothing  to  the 
total  income  ;  it  only  temporarily  overdraws  the  account 
at  the  banker's,  and  the  deficit  must  be  made  up.  But 
we  do  not  think  this  to  be  absolutely  true.     Both  for  a 


76  alcohol:  its  use- and  abuse. 

time,  in  some  healthy  persons,  and  constantly  in  many  who 
have  no  actual  evident  disease  but  a  defective  vital  action, 
the  use  of  alcohol  is  justifiable  and  desirable  ;  so  long  as 
only  so  much  is  taken  as  to  give  the  needed  stimulus  and 
no  more.  Chronic  diseases  require  chronic  remedies, 
and  so  do  chronic  defects  of  action. 

The  effects  produced  by  alcohol  in  certain  diseases 
show  beyond  a  doubt  that  it  has  a  certain  action  upon 
the  nervous  system,  which  we  can  only  call  stimulant  or 
tonic.  Especially  is  this  seen  in  some  cases  of  delirium 
in  fever,  and  in  failure  of  the  heart's  action  in  some  acute 
diseases.  In  such  cases  alcohol  is  sometimes  used  in  very 
large  and  repeated  doses  with  only  a  good  effect,  and 
without  any  subsequent  depression.  It  is  idle  to  ignore 
the  results  of  experience  in  disease  ;  they  are,  so  to  speak, 
only  the  same  on  a  very  large  and  visible  scale  as  those 
which  occur  in  a  less  tangible  form  in  the  lesser 
derangements  of  health. 

As  a  sedative^  i.e.  to  promote  rest  and  quiet,  or  sleep. — 
This,  as  we  have  seen,  is  the  sequel  of  the  former  effect, 
and  is  produced  mainly  by  the  action  upon  the  higher 
nervous  centres,  which  can  be  temporarily  paralysed  by 
alcohol.  In  ordinary  life,  however,  such  a  use  of  alcohol 
would  be  highly  mischievous  ;  even  in  disease,  the  result 
can  better  be  attained  by  other  means.  The  use  of  wine 
or  spirits  to  relieve  pain,  headache,  neuralgia,  and  the 


alcohol:  its  use  and  abuse.  77 

like,  is  one  of  the  greatest  danger ;  and  when  from  long 
continuance  of  the  cause  of  pain  the  habit  becomes 
constant,  the  diseases  caused  by  alcohol  are  most  cer- 
tainly produced.  Very  often  the  pain  is  really  caused 
by  the  use  of  the  alcohol,  and  ceases  on  its  withdrawal. 

Yet  there  are  exceptional  conditions  in  which  the  seda- 
tive effect  of  alcohol  in  a  moderate  degree  is  of  great 
value.  This  is  especially  the  case  where  over-mental 
activity  or  excitement  prevent  sleep  or  hinder  digestion. 
The  over-exhausted  brain  is  incapable  of  taking  rest; 
sleep  is  obtained  with  difficulty  owing  to  continual  active 
yet  useless  thought;  there  is  much  dreaming  and  the 
sleep  is  broken ;  in  the  daytime  there  is  drowsiness  and 
languor ;  the  appetite  is  gone.  Now  all  these  may  result 
from  the  use  of  alcohol,  but  they  may  also  arise  when 
no  alcohol  is  used,  simply  from  mental  exhaustion,  and 
then  a  small  quantity  of  alcohol  taken  regularly  gives 
great  rehef.  In  a  similar  way,  as  we  have  said,  by 
removing  mental  preoccupation,  appetite  and  digestion 
may  be  improved. 

In  elderly  persons  the  use  of  wine  or  spirits  and  water 
as  a  "  nightcap "  is  very  common,  and  in  many  cases 
beneficial ;  but  very  often  some  light  food  would  have  an 
equally  good  effect,  and  we  believe  that  in  most  cases 
where  it  is  really  needed,  some  food  should  be  taken 
with  it. 


;8  ALCOHOL :  its  use  and  abuse. 

It  must,  however,  always  be  remembered,  that  in  using 
alcohol  as  a  stimulant  or  sedative,  that  is,  distinctly  for 
either  of  those  objects,  we  are  entering  upon  a  course 
which  is  more  or  less  pernicious.  For  the  action  is  only 
temporary,  and  needs  repetition,  and  there  is  no  habit 
more  likely  to  cause  its  own  repetition  than  the  taking  of 
alcohol.  We  step  in  and  interfere  with  nature,  and  if 
nature  replies  by  reckoning  upon  our  interference,  we 
are  perhaps  in  a  worse  case  than  before.  If  we  accustom 
ourselves  to  boots  and  clothing,  nature  does  not  give  us 
hard  hoofs  and  a  dense  hairy  covering.  Our  acquired 
habits  are  some  of  the  strongest  parts  of  ourselves. 

Moreover,  there  is  no  doubt  that  we  can  do  work 
beyond  our  right  measure  and  standard  for  a  time  under 
the  influence  of  alcohol;  and  although  the  limit  as 
regards  bodily  work  is  soon  reached,  and  less  work  is 
done,  it  is  not  so  certainly  the  case  with  mental,  and  we 
may  readily  go  beyond  the  point  of  safety,  with  con- 
sequent weakening  of  our  powers. 

One  word  with  regard  to  the  diminution  of  alcohol  or 
its  entire  cessation  after  it  has  been  used  as  a  stimulant 
or  sedative.  Can  it  be  done  with  safety  ?  Unquestion- 
ably, if  in  a  person  in  ordinary  health,  it  may  be  with- 
drawn at  once  and  entirely ;  in  diseased  or  in  old  persons 
it  must  be  done  more  gradually  and  cautiously.  The 
cessation  is  often  attended  with  great  discomfort,  great 


ALCOHOL  :   ITS   USE   AND   ABUSE,  79 

craving  for  a  return  to  it;  but  this  is  no  indication  of 
injury  by  the  withdrawal,  it  shows  only  a  morbid  condition 
created  by  drinking.  We  may  say,  indeed,  that  such  a 
craving  is  of  itself  an  indication  that  more  had  been 
taken  than  was  needed.  Persons  who  take  only  a  mode- 
rate quantity  usually  suffer  no  discomfort  or  inconve- 
nience from  going  without  for  a  few  days,  though  they 
may  feel  the  better  for  returning  to  their  habitual 
allowance. 


CHAPTER  V. 

ALCOHOL    IN    ILL-HEALTH    AND    DISEASE. 

We  have  said  a  good  deal  about  the  effects  of  alcohol  in 
various  conditions  of  slight  ill-health,  and  it  may  be 
gathered  from  what  we  have  already  said  that  the  habitual 
use  of  alcohol  is  necessary  only  when  there  is  some  depar- 
ture from  health.  If  it  is  only  the  daily  friction  of  mental 
worry  or  bodily  fatigue  which  is  relieved  by  the  daily 
use  of  a  small  quantity  with  food,  just  as  grease  relieves 
the  friction  of  the  wheels  of  a  carriage,  it  is  the  slight 
degree  of  overwear  or  friction  of  the  system  which  makes 
us  need  it.  Now  there  are  many  conditions  of  ill-health 
in  which  alcohol  is  supposed  to  be  beneficial,  and  it  is 


So  ALCOHOL  :  ITS  USE  AND  ABUSE. 

one  of  the  most  difficult  tasks  of  the  doctor,  and  of  those 
who  wish  to  be  guided  by  reason  alone,  to  decide  whether 
in  such  or  such  a  case  alcohol  shall  be  taken,  and  in 
what  form. 

It  would  be  waste  of  time  to  go  into  all  these  various 
conditions,  and  to  try  to  suggest  the  appropriate  modicum 
for  each.  Patients  generally  expect  the  doctor  to  tell 
them  exactly  how  much  stimulant,  of  what  kind,  and  at 
what  time,  they  are  to  take.  Some  follow  blindly  and 
exactly  the  instructions  given,  and  this  veiy  wisely; 
others  hedge  a  good  deal,  they  take  less  or  more  as  their 
inclination  tends.  If  people  would  deal  fairly  and 
honestly  with  themselves,  they  could  often  judge  far 
better  than  the  doctor  what  is  good  for  them.  People 
often  ask  the  doctor  such  a  question  as  this  :  "  Do  you 
think  three  or  four  glasses  of  sherry  a  day  would  do  me 
harm  ?"  If  he  says,  "  Yes,  take  only  two,"  the  chances 
are  that  they  will  still  take  as  much  as  before ;  if  he  says 
"  No,"  they  will  take  it  too,  though  all  the  while  knowing 
that  it  does  harm  them.  In  a  large  majority  of  cases  the 
truest  answer  is,  "  You  can  judge  far  better  yourself,  both 
what  form  agrees  with  you  best,  and  how  much  you 
really  need  ;  take  that  form  which  you  can  digest,  and  as 
little  of  it  as  possible."  Men  are  too  willing  to  leave 
others  to  judge  for  them,  especially  when  the  advice 
jumps  with  their  own  inclination,  and  they  need  to  be 


alcohol:  its  use  and  abuse.  8i 

brought  honestly  to  use  their  own  reason  and  act  on 
their  own  responsibihty. 

Knowledge  of  the  individual  and  his  habits,  of  the 
tendencies  of  certain  states  of  constitution,  and  the  like, 
do,  however,  often  enable  the  doctor  to  form  an  accurate 
judgment  as  to  what  is  best. 

Certain  constitutions  do  not  tolerate  certain  forms  of 
stimulants,  and  some  are  always  injured  by  alcohol. 
Every  one  knows  that  gouty  people  should  not  take 
young  port,  or  sweet  wines ;  that  many  dyspeptics  cannot 
take  ale  or  stout ;  that  elderly  persons  often  cannot  take 
claret,  and  so  on.  Some  of  these  difficulties  are  due  to 
the  other  bodies,  such  as  sugar,  salts,  &c.,  contained  in 
the  various  liquors.  But  we  could  not  go  into  all  these 
points  in  a  work  like  the  present,  and  no  one  but  a 
doctor  could  be  expected  fully  to  appreciate  the  minute 
shades  of  difference  if  we  did.  If  one  man  finds  that 
beer  gives  him  dyspepsia  or  headache,  and  claret  does 
not — if  port  flushes  his  face  and  makes  him  feel  stupid, 
and  champagne  does  not — if,  in  fact,  one  thing  suits  him 
and  the  other  does  not,  he  does  not  want  a  doctor  to  tell 
him  which  to  take,  so  long  as  he  possesses  any  amount 
of  his  reasoning  faculties ;  but  he  may  need  to  be  told 
that  he  would  be  far  better  without  any  at  all. 

We  must  rather  try  to  indicate  what  states  of  health 
show  that  alcohol  as  such  is  injurious  or  beneficial. 


82  ALCOHOL  :  ITS  LSE  AND  ABUSE. 

"  Indigestion"  is  one  of  the  common  complaints  for 
which  alcohol  is  used.  "  Take  a  little  wine  for  thy 
stomach's  sake "  is  a  very  old  prescription,  but  wanting 
in  explicity  both  as  to  the  quantity  and  nature  of  the 
wine.  There  are  many  forms  of  indigestion — one  of  the 
commonest  in  some  classes  is  actually  caused  by  alcohol, 
as  we  have  already  said.  For  this  the  remedy  is  entire 
abstention.  So,  too,  when  the  water  is  high-coloured 
and  loaded  in  the  morning,  the  tongue  coated,  much 
thirst,  drowsiness  and  heaviness  during  the  day,  the 
bowels  sluggish,  dull  aching  in  the  right  side,  &c.,  we 
may  strongly  suspect  over-indulgence  in  the  pleasures  of 
the  table,  both  in  meat  and  drink,  and  counsel  abstinence 
in  both,  and  more  exercise.  But  when  there  is  loss  of 
appetite,  with  a  pale  clean  tongue,  slight  pain  after  food, 
capricious  likings  and  loathings,  and  other  symptoms 
showing  difficulty  in  digestion  in  a  person  not  in  the 
habit  of  taking  alcohol,  it  may  often  be  given  with  food 
with  very  great  advantage.  We  come  back,  however,  to 
our  starting-point,  that  every  case  must  be  judged  on  its 
own  merits,  that  other  treatment  should  in  most  cases  be 
employed,  and  that  the  kind  and  quantity  of  stimulant  is 
to  be  regulated  by  the  doctor's  advice  and  the  person's 
own  experience.  "Indigestion"  is  only  a  name  for  a 
condition  varying  widely  in  its  causes  and  symptoms.  It 
may  easily  be  aggravated  by  the  use  of  alcohol,  or  by  use 


alcohol:  its  use  and  abuse.  83 

of  it  in  the  wrong  form,  or  at  wrong  times,  or  it  may 
be  greatly  relieved  by  it,  and  we  should  lead  into  error 
if  we  tried  to  go  too  much  into  detail.  Experience  is 
after  all  the  best  guide  in  any  individual  case,  but  an 
honest  trial  of  total  abstinence  is  always  well  worth 
making. 

We  may  lay  it  down  as  a  universal  rule  that  if  alcohol 
is  to  benefit  digestion  it  must  be  taken  with  or  soon  after 
meals,  that  only  a  moderate  quantity  such  as  we  have 
already  indicated  must  be  taken,  and  that  the  form  must 
be  regulated  by  experience.  Beyond  these  general 
maxims  we  cannot  here  afford  space  to  lay  down  any 
fixed  rules. 

Neuralgia  in  all  its  varied  forms,  and  nerve  pains  of 
whatever  kind,  are  generally  supposed  to  demand  the  use 
of  alcohol.  It  is  here  that  the  narcotic  effect  of  alcohol 
is  most  frequently  sought.  If  we  go  through  the  whole 
series  of  pains  and  aches  to  which  our  human  frame  is 
subject  we  shall  find  hardly  one  in  which  alcohol  has 
not  been  recommended  as  a  specific.  Toothache,  tic- 
douloureux,  headache,  &c.,  are  often  treated  with  large 
doses  of  brandy  or  port  wine,  and  in  many  cases  with 
great  benefit,  at  least  for  a  time.  Alcohol  has  in  such 
cases  a  double  action ;  it  makes  the  sensation  of  pain  less 
by  deadening  the  sensibility  of  the  brain,  and  probably 
also  it  acts  upon  the  vessels  of  the  affected  part,  changes 


84  ALCOHOL  :  ITS  USE  AND  ABUSE. 

the  relations  of  the  vessels  and  nerves,  and  so  alters  and 
possibly  relieves  the  pain.  But  in  many  cases,  though  it 
gives  relief  for  a  time,  the  pain  returns  with  renewed 
vigour^  and  more  alcohol  must  be  taken,  and  so  on.  It  is  the 
nature  of  all  nerve  pains  to  come  and  go,  and  to  be  aggra- 
vated by  diseased  or  unhealthy  conditions  of  the  general 
system,and  unless  there  be  some  serious  direct  irritation  of 
the  nerve,  to  last  only  for  a  certain  time  and  then  go  away. 
When  pain  is  very  severe  and  agonising,  it  is  on  all 
accounts  desirable  to  relieve  it,  for  nothing  is  more 
wearying  to  the  human  frame  than  severe  pain.  And  for 
this  we  may  use  alcohol  if  we  have  no  better  means  of 
relief,  but  we  ought  fully  to  understand  why  we  use  it. 
It  is  not  to  cure,  and  we  may  have  to  reckon  with  the 
possibility  of  the  general  state  which  causes  the  pain 
being  made  worse. 

It  cannot  be  too  clearly  understood  that  most  neu- 
ralgias have  a  general  as  well  as  a  local  cause.  How 
many  people  do  we  see  who  suffer  agonies  from  toothache 
or  earache  whenever  they  get  overworked  or  out  of 
health.  Their  teeth  may  be  as  rotten  as  touchwood,  but 
so  long  as  they  are  in  good  health  they  feel  nothing 
amiss  ;  give  them  a  few  days'  overwork,  want  of  sleep,  or 
anxiety,  and  they  hurry  to  the  dentist  to  have  their  teeth 
drawn.  Now  in  very  many  such  cases  the  amount  of 
alcohol  which  relieves  pain  gives  rise  to  dyspepsia,  or 


alcohol:  its  use  and  abuse.  85 

to  subsequent  debility,  and  so  indirectly  aggravates  the 
suffering. 

We  are  not  speaking  here  of  the  local  use  of  alcohol  in 
the  form  of  brandy  or  rum,  which  sometimes  has  a  very 
good  effect  in  the  relief  of  pain,  e.g.,  in  a  tooth,  or  apphed 
to  the  face  in  neuralgia.  This  use  is  a  harmless  one,  too 
well  known  as  a  homely  remedy  to  need  recommen- 
dation here. 

What  we  have  said  of  the  use  of  alcohol  in  severe 
acute  neuralgia  applies  with  greater  force  to  its  employ- 
ment in  long-standing  or  recurrent  pain,  and  indeed 
nearly  all  chronic  nervous  diseases.  In  no  condition  is 
the  use  of  alcohol  so  likely  to  become  dangerous,  and  to 
make  the  mind  and  body  slaves  to  it.  This  is  equally 
true  of  the  real  bodily  pains  and  discomforts  to  which 
so  many  are  subject,  and  those  mental  pains  which,  like 
dank  vapours,  arise  from  the  body  and  becloud  the  mind 
and  soul.  For  those  who  really  suffer  pain  of  body  find 
that  drinking  for  a  time  relieves  their  sense  of  misery, 
but  only  so  long  as  the  alcohol  is  acting;  when  it  has 
ceased  they  are  as  bad  as,  or  worse  than,  ever,  so  that 
they  again  seek  the  bottle.  By  degrees  they  find  that 
they  need  more  frequent  and  larger  doses  to  relieve  their 
pain  and  discomfort,  nor  can  they  be  for  any  length  of 
time  without  it ;  and  so  from  occasional  small  doses  they 
slide  into  constant  tipphng.     Soon  they  find  that  when 


86  ALCOHOL  :    ITS   USE    AND    ABUSE. 

they  are  not  drinking  they  have  not  only  their  original 
pain  but  the  malaise  and  wretchedness  which  result  from 
alcohol  itself,  and  they  must  take  more  to  remove  their 
sense  of  complicated  misery.  Thus  from  moderate 
drinkers,  using  alcohol  in  a  strictly  medicinal  way,  they 
become  by  degrees  habitual  drunkards,  and  ruin  their 
health,  constitution,  and  entire  well-being,  physical  and 
moral. 

Hypochondriacal  and  *'  nervous "  people,  who  are 
readily  "  hipped,"  whose  lives  are  made  wretched  by  a 
sense  of  misery  which  has  no  external  or  evident  cause, 
are  often  led  into  drinking.  But  they  only  aggravate 
and  extend  their  wretchedness,  and  may  say — 

*'  Sad  once  were  we 
In  the  sweet  air  made  gladsome  by  the  sun  ; 
Now  in  these  murky  settlings  are  we  sad." 

They  had  to  start  with  too  little  control  over  their 
sensations  and  feelings,  and  what  they  had  they  lose; 
find  thus  the  soul 

*' Yields  her  body  to  a  fiend, 

Who  after  moves  and  governs  it  at  will, 

'Till  all  its  time  be  rounded." 

Whatever  benefit  there  may  be  in  the  use  of  alcohol  to 
"  one  that  is  of  sorrowful  heart "  for  a  time,  there  is  the 
greatest  danger  in  it  to  those  who  are  so  by  nature  and 


ALCOHOL  :    ITS    USE   AND    ABUSE.  87 

habit ;  when  once  they  begin  to  use  it  they  become 
gradually  enslaved,  and  the  craving  for  drink  is  the 
tangible  fomi  which  their  longing  for  some  relief  takes 
on.  They  may,  it  is  true,  in  like  manner  become  slaves 
to  opium  or  other  narcotics,  but  it  is  rarely  that  they  do 
not  take  spirits  too,  either  at  the  same  time  or  alternately 
with  opium  or  morphia. 

At  some  periods  of  life  there  is  an  especial  tendency 
to  drinking,  owing  to  abnormal  or  morbid  sensations 
caused  by  altered  functional  states.  One  of  the  most 
dangerous  of  these  is  the  change  of  life  in  women,  and  it 
is  at  this  period  that  many  previously  sober  and  moral 
women  become  addicted  to  drinking,  often  in  secret  at 
first,  and  lay  the  foundation  of  habits  which  shorten  the 
life  and  degrade  the  character.  No  doubt  this  tendency 
is  encouraged  by  custom  and  the  influence  of  bad  advice, 
but,  in  many  cases,  there  is  a  very  strong  incHnation 
towards  drinking  which  needs  nothing  but  the  possi- 
bility of  secret  gratification  to  cause  it  to  be  indulged 
in.  Those  who  have  not  had  the  opportunities  which 
doctors  unfortunately  enjoy  of  hearing  the  sad  revelations 
which  are  sometimes  made  on  this  subject,  would  be 
astonished  at  the  amount  of  secret  drinking  amongst 
apparently  respectable  and  sober  middle-aged  women. 

In  the  state  of  maternity  and  childbirth  the  same  is 
true  to  an  enormous  extent.     The  amount  of  drinking 


88  ALCOHOL  :  ITS  USE  AND  ABUSE. 

which  is  carried  on,  both  at  these  times  and  by  nursing 
mothers,  under  a  wrong  idea  of  the  necessity  for  alcohol, 
and  an  entire  misconception  of  its  true  action,  is  almost 
beyond  belief.  On  no  subject  connected  with  drinking 
is  it  more  necessary  to  speak  emphatically,  for  the 
direct  and  indirect  effects  of  such  a  misuse  are  evils  of 
incalculable  extent.  It  seems  to  have  become  one  of  the 
doctrines  and  tenets  of  the  female  world  that  alcohol  is 
essential  to  women  who  are  nursing,  and  that  it  is  not 
only  a  benefit  to  them,  but  their  duty  to  take  a  considerable 
quantity.  If  this  error  were  confined  to  the  lower  classes 
we  might  not  be  surprised,  but  unfortunately  it  is  equally 
common  in  the  higher.  Monthly  nurses  are  probably  more 
chargeable  with  spreading  drunkenness  among  married 
women  than  any  other  class.  Their  position  and  supposed 
experience  as  "  wise  women  "  enable  them  to  insinuate  the 
temptation  and  propagate  the  error,  in  spite  of  all  the 
efforts  of  doctors  and  moralists.  Young  mothers  especially 
are  led  by  their  advice  as  if  they  were  bound  hand  and 
foot ;  and,  in  spite  of  their  better  judgment,  they  give  way 
to  their  leaders  in  a  hitherto  unknown  land,  and  blindly 
follow  their  blind  guides. 

The  evil  thus  brought  upon  young  married  women  is 
enormous,  and  the  result  in  physical  and  moral  deteriora- 
tion is  most  saddening.  But  this  is  not  by  any  means 
the  sole  evil  effect,  for  the  habit  tells  upon  the  offspring 


alcohol:   its  use  and  abuse.  89 

whom  it  is  intended  to  benefit.  We  are  not  speaking  of 
the  effect  of  drunkenness  in  the  mother,  which  has  ter- 
rible results  in  infant  mortality  or  life-long  disease,  but 
the  result  of  drinking  more  than  is  habitual  or  moderate, 
the  effect  of  which,  though  less  in  degree,  is  of  the  same 
kind ;  and  there  is  the  strongest  probability  that  the 
moral  and  mental  character  of  children  is  influenced  by 
the  action  of  alcohol  in  the  mother,  and  greater  misery 
thus  caused  than  even  by  crippling  or  fatal  disease. 

There  is  no  evidence  that  alcohol  is  more  necessary 
or  beneficial  to  mothers,  as  such,  and  all  experience 
points  strongly  in  the  opposite  direction ;  so  that  those 
who  wish  to  preserve  their  own  health,  and  the  hfe  and 
health  of  their  children,  should  resist  the  bad  advice  so 
often  pressed  upon  them,  and  avoid  alcohol  as  much  as 
possible. 

Alcohol  in  Disease. — It  may  be  thought  that  we  have 
said  very  little  as  to  the  use  of  alcohol  in  disease.  Most 
people,  at  any  rate  doctors,  admit  that  alcohol  is  a  most 
valuable  drug,  and  those  who  have  had  to  deal  much 
with  severe  disease  know  of  what  immense  value  it  is  in 
many  cases.  We  have  mentioned  some  of  the  slighter 
ailments  in  which  't  is  useful,  but  beyond  this  we  must 
not  go  here.  For  whilst  alcohol  may  be  used  with  great 
benefit,  and  in  very  large  doses  in  some  diseases,  the 
knowledge  of  how  and  when  to  use  it  with  profit  is  one 


QO  ALCOHOL  :    ITS   USE   AND    ABUSE. 

of  these  points  which  require  all  the  special  skill  and 
experience  of  the  physician,  and  the  indications  for  its 
use  require  technical  knowledge  which  we  could  not  here 
impart.  It  is  especially  in  acute  diseases  and  fevers,  and 
in  some  diseases  of  the  nervous  system  and  heart,  that  it 
finds  its  greatest  use ;  but  in  such  cases  it  should  always 
be  given  as  a  medicine  in  carefully  measured  doses,  and 
at  stated  times,  and  never  left  to  the  discretion  either  of 
the  nurse  or  the  patient.  Nor  let  it  be  imagined  that 
caprice  or  educational  bias  is  the  guide  of  the  doctor  in 
giving  or  withholding  alcohol ;  there  is  no  drug  the  effects 
of  which  in  disease  have  been  more  minutely  and  scien- 
tifically investigated  of  late  years  than  alcohol,  and  a 
great  mass  of  accurate  knowledge  as  to  its  effects  is  the 
result;  so  that  he  who  pretends  that  giving  alcohol  is 
merely  a  matter  of  conjecture  or  routine  is  either  an 
ignoramus  or  a  quack. 

And,  lastly,  the  common  use  of  brandy  in  all  sorts  of 
ailments,  as  a  specific,  cannot  be  too  earnestly  deprecated. 
It  is  quite  true  that  in  many  slight  ailments  it  gives 
relief,  and  in  some  is  very  useful  when  no  other  remedy 
is  at  hand ;  for  example,  in  colic  or  diarrhoea,  in  ex- 
haustion or  fainting,  in  shock  from  accident,  and  the 
like.  We  have  purposely  avoided  discussing  its  use 
under  these  circumstances,  because  we  are  convinced 
that  there  is  no  need  to  mention  all  the  conditions  which 


alcohol:  its  use  and  abuse.  91 

may  call,  for  it,  and  that  what  needs  to  be  said  is  more 
in  the  way  of  caution  than  advice.  For  in  a  very  large 
number  of  cases,  the  giving  of  brandy  actually  does  harm, 
in  many  others  it  does  no  good,  and  obscures  the  true 
nature  of  the  case  when  the  doctor  is  called  in.  A  man 
is  seen  to  reel  and  stagger  in  the  street ;  the  bystanders 
gather  round  him ;  he  complains  of  being  sick  and  faint, 
perhaps  falls  and  becomes  partially  unconscious.  The 
two  things  which  kind  neighbours  or  good  Samaritans  do 
are,  first  to  try  to  help  him  to  stand  up,  and  then  to 
fetch  him  some  brandy,  or  to  support  him  to  the  nearest 
public-house  to  get  some,  and  then  pour  down  a  large 
quantity.  And  thus  many  a  case  of  commencing  apoplexy 
has  been  aggravated  and  made  fatal ;  or  a  man  with  heart 
or  brain  disease  taken  to  a  police-cell  as  drunk,  and  died 
there.  AVe  believe  that  in  by  far  the  majority  of  cases 
the  rough-and-ready  treatment  of  ignorant  persons  has 
thus  been  absolutely  injurious  ;  in  very  few  beneficial. 

The  use  of  spirits  has  often  been  supposed  to  aid  in 
preventing  the  attacks  of  fever,  ague,  and  other  infectious 
and  malarial  diseases.  The  experience  on  this  point 
derived  from  army  statistics  seems  to  show  that  alcohol 
has  no  effect  in  warding  off  malarial  fever,  cholera,  or 
dysentery.  Nor  does  its  presence  promote  attack.  Yellow 
fever  is  peculiarly  fatal  to  intemperate  persons.  With 
regard  to  other  fevers,  we  have  no  evidence  that  they  are 


92  ALCOHOL  :    ITS    USE   AND    ABUSE, 

at  all  prevented  by  alcohol,  and  they  are  certainly,  like 
nearly  all  other  diseases,  more  fatal  in  persons  who  have 
indulired  to  excess  than  in  others. 


CHAPTER  VI. 

THE   RIGHT   USE   OF    ALCOHOL. 

We  have  thus  briefly  discussed  the  various  uses  and 
abuses  of  alcohol ;  and  from  what  we  have  said,  it  is  evi- 
dent that  alcohol  has  a  right  use,  as  an  article  of  diet  and 
as  a  medicine ;  but  that  it  may  be  easily  misused  through 
ignorance  of  its  action,  as  well  as  from  w^ilful  indulgence 

Upon  the  dietetic  use  of  alcohol  we  cannot  do  better 
than  quote  the  words  of  the  late  lamentexLDr..Parkes^, 
which  will  meet  with  the  concurrence  of  all  right-thinking 
men. 

"  The  dietetic  value  of  alcohol  has  been  much  over- 
rated. It  does  not  appear  to  me  possible  at  present  to 
condemn  altogether  alcohol  as  an  article  of  diet  in  health  ; 
or  to  prove  that  it  is  invariably  hurtful,  as  some  have  at- 
tempted to  do.  It  produces  effects  which  are  often  useful 
in  disease,  and  sometimes  desirable  i-n  health  ;  but  in 
health  it  is  certainly  not  a  necessity,  and  many  persons 
are  much  better  without  it.  As  now  used  by  mankind  it 
is  infinitely  more  powerful  for  evil  than  good." 


ALCOHOL  :    ITS    USE    AND    ABUSE.  93 

It  is  only  needful  now  briefly  to  gather  together  some 
hints  as  to  the  mode  in  which  alcohol  should  be  used,  if 
at  all. 

Choice  of  a  Beverage. — First  in  order  comes  the  choice 
of  a  beverage.  We  cannot  attempt  to  prescribe  the  right 
kind  of  alcoholic  stimulant  for  each  individual.  We  have 
shown  that  each  has  its  own  peculiar  properties  ;  that  the 
most  healthful  and  least  injurious  forms  are  those  which 
contain  alcohol  in  the  smallest  quantity,  and  in  the  most 
combined  form.  Spirits  are  directly  injurious  to  the 
tissues  with  which  they  come  in  contact,  and  cause  de- 
struction of  other  organs  most  rapidly ;  hence  their  habi- 
tual use  is  only  to  be  permitted  when  necessitated  by 
disease,  or  when  there  is  absolute  incapacity  to  tolerate 
any  other  form.  Wines  have  their  especial  use  in  relation 
to  digestion  and  nutrition  ;  the  stronger  wines  form  a 
class  quite  distinct  from  the  lighter  in  this  respect.  For 
ordinary  use  the  lighter  wines  alone  should  be  taken, 
those  having  less  than  lo  per  cent,  of  alcohol  being  pre- 
ferable, and  ale  or  stout  being  still  more  advantageous, 
as  affording  nutriment,  and  tonic  and  digestive  principles 
in  addition. 

Beyond  these  general  principles,  the  selection  must  be 
determined  by  individual  constitution. 

Quantity  of  Alcohol. — The  quantity  daily  should  not 
exceed  half-an-ounce  of  absolute  alcohol^  and  even  this  is 


94  alcohol:  its  use  and  abuse. 

a  limit  which  should  not  be  reached  if  less  can  be  taken. 
To  take  one  ounce  daily  is  to  reach  nearly  the  limit  of 
diminished  power,  and  it  goes  beyond  the  bounds  of 
safe  stimulation.  We  must  here  refer  to  what  we  have 
already  said  (see  p.  12)  as  to  the  quantity  of  various 
liquors  which  contain  this  amount. 

Summary  of  Conclusions. 

1.  In  health  the  use  of  alcohol  is  unnecessary,  and  its 
habitual  employment  is  liable  to  produce  disease,  hence 
total  abstinence  is  the  safest  course. 

2.  When  the  habitual  use  of  alcoholic  beverages  in 
some  form  is  found  necessary,  the  following  rules  are  to 
be  observed : — 

The  quantity  must  be  the  least  possible,  and  usually 
not  more  than  that  containing  half-an-ounce  of  absolute 
alcohol  per  diem. 

Th^form  should  always  be  dilute,  and  the  alcohol  in 
a  state  of  intimate  combination.  Wines  containing  more 
than  10  per  cent,  of  alcohol  should  not  be  drunk  undi- 
luted. 

The  time  should  be  always  with  meals,  preferably  only 
with  dinner ;  never  in  the  morning  or  between  meals. 

3.  In  very  many  cases  where  alcoholic  beverages  may 
be  used  temporarily  with  advantage  no  definite  rules  can 


ALCOHOL  :    ITS    USE    AND    ABUSE.  95 

be  laid  down  other  than  those  given  in  the  preceding 
pages.  But  let  the  dangers,  moral,  social,  and  physical, 
of  excess  in  drinking  always  be  borne  in  mind,  and  con- 
trol the  action  in  this  matter. 

4.  In  disease  alcohol  should  be  used  only  as  a  medi- 
cine, and  the  quantity,  quality,  and  time  strictly  regulated 
by  the  doctor's  orders. 

If  these  rules,  and  the  principles  upon  which  they  are 
grounded  were  observed,  we  should  not  have  to  lament 
the  ruin  of  health  and  constitution,  and  the  increase  of 
vice  and  crime  which  now  result  from  excessive  drinking. 

W.  S.  GREENFIELD. 


List  of  Principal  Authorities  for  Reference. 

Anstie,  Dr.  F.  E.     Ou  Stimulants  and  Narcotics.     London,  1864. 
,     On  the  Use  of  Wines    in  Health   and  Disease.     London, 

1877. 
Carpenter,   Dr.  W.  B.,   F.R.  S.      Ihe  Physiology  of  Temperance 

and  Total  Abstinence.     London,  1870. 
Huss-Magnus.     Alcoholismus  Chronicus. 

Magnan,  Dr.  V.     On  Alcoholism.     (Translation.)     London,  1876. 
Parkes,   Dr.  E.  A.,   F.R.S.     On  Hygiene.     Fourth  edition,   1873, 

p.  279  et  seq. 

.     Personal  Care  of  Health. 

Richardson,  Dr.  B.  W.,  F.R.S.     On  Alcohol. 

Report    of    Committee    of    Convocation   of    Canterbury   on    In 

temperance. 
Report  of  the  Committee  of  the  House  of  Lords  on  Intemperance. 
7 


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This  book  is  DUE  on  the  last  date  stamped  below 


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